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Osteopathy Y3S1 > Week 9 - Male Reproductive System and Disorders > Flashcards

Week 9 - Male Reproductive System and Disorders Flashcards

1
Q

Review the anatomy of the male perineum. What structures are located in the (i) anal triangle and (ii) urogenital triangle?

A
  • Anal triangle
    • anal aperture (opening of anus)
    • external anal sphincter muscle (voluntary muscle that opens/closes anus)
    • ischioanal fossa (x2) (spaces located laterally to the anusm, containing fat and connective tissue)
    • pudendal nerve
  • Urogenital triangle (superficial to deep)
    • deep perineal pouch (urethra, external urethral sphincter, bulbourethral glands and deep transverse perineal muscles)
    • perineal membrane (tough fascia perforated by the urethra; provides attachment for muscles of external genitalia)
    • superficial perineal pouch (contains erectile tissue that form the penis and three muscles - ischiocavernosus, bulbospongiosus and superficial transverse perineal muscles; greater vestibular glands)
    • perineal fascia (continuation of abdominal fascial)
    • skin
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2
Q

Review the layers of the scrotum. What is the function of the dartos and cremaster muscles?

A
  • skin and superficial fascia (contains dortos muscle - smooth muscle)
  • external spermatic fascia (continuation of external oblique aponeurosis)
  • cremaster muscle (originates from internal oblique muscle - skeletal muscle)
  • cremaster fascia (continuation of internal oblique aponeurosis)
  • internal spermatic fascia (continuation of transversalis fascia)
  • tunica vaginalis (derived from an outpouching of the peritoneum, the vaginal process)
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3
Q

List the components of the spermatic cord. How does the spermatic cord enter the pelvis?

A
  • blood vessels
    • testicular artery (branch of aorta that arises just inferiorly to the renal arteries)
    • cremasteric artery and vein
    • artery to vas deferens
    • pampiniform plexus of testicular veins
  • nerves
    • genital branch of genitofemoral nerve (supplies cremastic mm)
    • autonomic news
  • other structures
    • vas deferens
    • processus vaginalis
    • lymph vessels
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4
Q

Differentiate the terms tunica vaginalis and tunica albuginea

A
  • tunica vaginalis is an outpouching of the peritoneum and covers the tunica albuginea (excluding points at which the epididymis attaches to the testis)
  • between visceral and parietal layers of tunica vaginalis, there is a fluid-filled cavity
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5
Q

What embryological structure does the tunica vaginalis develop from? What adult disorders are associated with this structure?

A
  • vaginal process
  • adult disorders associated with this structure include:
    • inguinal hernia
    • hydrocele
    • cryptorchidism
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6
Q

List the cell types found in the seminiferous tubules. Briefly describe the function of each type of cell.

A
  • spermatogenic cells (produce sperm)
  • sustentacular (Sertoli) cells (support the spermatogenic cells and nourish developing sperm; bind testosterone)
  • interstitial endocrine cells (Leydig) cells (produce androgens, largely testosterone)
  • myoid cells (contract rhythmically to squeeze sperm and fluids out of the seminiferous tubules)
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7
Q

Explain the hormonal regulation of testicular function. Items to include:

  • (i) The hypothalamus and anterior pituitary gland
  • (ii) Gonadotrophin-releasing hormone
  • (iii) Follicle stimulating hormone and luteinising hormone
  • (iv) Interstitial cells and sustentacular cells
  • (v) Testosterone & androgen-binding protein
  • (vi) Negative feedback
A
  • stimulus: low testerone levels
  • hypothalamus releases gonadotrophin-releasing hormone (via the hypothalamic-pituitary-gonadal axis) to anterior pituitary gland (APG)
  • APG releases follicle stimulating hormone (FSH) and luteinising hormone (LH) in response
    • LH stimulates interstitial cells to produce testosterone
    • FSH stimulate sustentacular cells to produce androgen-binding protein (ABP)
      • ABP maintains a high concentration of testerone for spermatogenic cells
  • negative feedback is sent to the anterior pituitary gland and hypothalamus via testosterone (interstitial cell) and inhibin (sustentacular cell), respectively
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8
Q

List five effects of testosterone

A
  • triggers spermatogenesis
  • maturation and maintenance of the male reproductive tract
  • drives male libido
  • development of secondary sex characteristics (e.g. hair growth, laryngeal enlargement, thicker oilier skin)
  • anabolic effect (bone growth and muscle mass)
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9
Q

Testosterone is converted to other hormones in certain tissues of the male body. Provide examples of these hormones and tissues.

A
  • Hormones:
    • Dihydrotestosterone (DHT)
    • Estradiol
  • Tissues:
    • adipose tissue
    • target tissues
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10
Q

Describe the sensory nerve supply to the penis

A
  • autonomic supply
    • hypogastric and pelvic plexuses consist of fibres from:
      • sympathetic fibres (T12-L2)
      • parasympathetic fibres (S2-S4)
      • visceral afferents
  • somatic supply
    • pudendal nerve (S2-S4) and its terminal branch, the dorsal nerve of the penis
      • somatic sensory supply to most of the penis
      • somatic motor supply to bulbospongiosus, ischiocavernosus
    • branches of ilioinguinal nerve (L1) supply skin to the root of the penis
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11
Q

Which part of the nervous system is responsible for establishing an erection?

A
  • a reflex erection is mediated by parasympathetic fibres, which release nitric oxide to relax smooth muscle in penile arterioles
  • vasodilation leads to engorgement of the corpora cavernosa and corpus spongiosum leading to an erection
  • also, psychogenic erection involves control of sympathetic nerves (T10-L2), where parasympathetic nerves (S2-S4) also contribute
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12
Q

Which parts of the nervous system are responsible for ejaculation?

A
  • emission - the production and release of semen from reproductive gland and contraction of reproductive ducts, which propel the sperm into the urethra of the penis. Controlled by the sympathetic nerves from the levels T11-L2
  • ejaculation - releasing of sperm and semen from the urethra. spinal nerves from the S2-S4 levels (sympathetic) control ejaculation and transmit sensation from the genitals to the brain
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13
Q

List the ducts in the male reproductive system, from the rete testis to the external urethral orifice

A
  • epididymis (posterior surface of each testis; connects the rete testis to the ductus deferens)
  • ductus deferens (continuous with tail of epididymis; conveys sperm from epididymis to ejaculatory duct)
  • ejaculatory ducts (convergence of ductus deferens with duct of seminal gland)
  • urethra (prostatic urethra receives content from ejaculatory ducts; begins as preprostatic urethra in bladder neck, continues as prostatic urethra, then membranous urethra and terminates as spongy urethra which passes throught the bulb and corpus spongiosum)
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14
Q

Annotate your diagram with the relative position of the following structures:

  • (i) Seminal vesicles
  • (ii) Bladder
  • (iii) Prostate gland
  • (iv) Bulbourethral glands
  • (v) Internal urethral sphincter
  • (vi) External urethral sphincter
A
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15
Q

How would you introduce the prostate gland in the setting of a lab exam (structure/function/location)?

A
  • Structure - the prostate is a 3cm-long ‘walnut’-shaped gland - the largest accessory gland in the male reproductive system. It is made up of 20-30 tubuloalveolar glands that are embedded in the stroma
  • Location - the prostate encircles the prostatic urethra (closely related to the neck of the bladder)
  • Function - secretes a slightly alkaline fluid that constitutes 30% of the volume of semen, which helps to neutralise the acidity of the vaginal tract, prolonging the lifespan of sperm
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16
Q

Label this diagram of the prostatic zones (indicate the relative position of these zones to the prostatic urethra and ejaculatory ducts)

A
  • transition zone - surrounds prostatic urethra
  • central zone - base of prostate, surrounding the ejaculatory ducts
  • peripheral zone
  • anterior fibromuscular stroma
17
Q

What is the function of the glandular portion of the prostate?

A
  • produces an alkaline milky fluid that accompanies spermatozoas in the semen
  • neutralises the acidic environment of the vagina
  • thereby, increases the lifespan of sperm
18
Q

List the components of the supporting stroma of the prostate. Briefly describe the function of each component.

A
  • fibrous connective tissue (contribute to the structural integrity of gland)
  • smooth muscle fibres (possess alpha-1 adrenergic receptors that respond to sympathetic nervous stimulation)
  • prostatic interstitial cells (regulate resting tone of smooth muscle)
19
Q

Define the term ‘Benign Prostatic Hyperplasia’ and describe the aspect of the prostate gland that is typically affected in this condition.

A
  • Hyperplasia (increased number of cells) of stromal and glandular components of the prostate gland
  • Affects the transition zone
  • Not considered to be a pre-malignant lesion
20
Q

Identify the most common form of prostatic cancer and describe the aspect of the prostate gland that is typically affected in this condition.

A
  • Adenocarcinoma
  • Peripheral zone typically affected
21
Q

Compare and contrast the aetiology and clinical features of BPH and Prostatic cancer.

A
  • Same
    • Clinical features - BPH and Prostatic Carcinoma result in clinical features indicating potential obstruction or irritation (e.g. hesistancy = obstruction; urgency and frequency = irritation)
    • Aetiology - genetics and age may play a factor in the development of both BPH and Prostatic Carcinoma
  • Different
    • Aetiology:
      • BPH - current thinking relates to imbalance of dihydrotestosterone (DHT) and growth factors
      • Prostate cancer -
    • Clinical Features:
      • BPH - DRE findings include a smooth, elastic prostate
      • Prostate carcinoma - DRE findings include a craggy, hard prostate; also, consider systemic features
22
Q

List the common routes for the metastasis of prostatic cancer. Are there any osteopathic implications associated with the spread of this disease

A
  • Metastasis can occur before urinary obstruction develops
  • Spread via blood or lymphatics
  • Predilection for spine (communication with vertebral drainage and lymphatic drainage into lumbars)
    • Weak bone is a contraindication for a number of osteopathic techniques
23
Q

Name two classes of medication that can be used in the treatment of BPH and briefly describe the mechanism of action of each.

A
  • alpha-5-reductase inhibitors (decreases conversion of androgens into DTH)
  • alpha-1 receptor inhibitors (minimises contraction of prostate, sympathetic nervous response)
24
Q

Define the term inguinal hernia

A
  • the protrusion of abdominal contents (intestines, omentum) into the inguinal canal
25
Q

Differentiate an indirect (lateral) hernia from a direct (medial) hernia

A
  • indirect (lateral) hernia: hernia sac passes through the deep inguinal ring and runs in the inguinal canal (in males, within spermatic cord)
  • direct (medial) hernia: bulges directly through the posterior wall of the inguinal canal
26
Q

Summarise the risk factors associated with the development of an inguinal hernia

A
  • INDIRECT HERNIAL RISK: patent (unclosed/continuous peritoneal outpouching) vaginal process
  • DIRECT HERNIAL RISK: weakness in transversalis fascia
  • other risk factors:
    • male sex
    • advanced age
    • occupations involving increased lifting and standing/walking
    • connective tissue disorders
    • inguinal cryptorchidism (testicle has been halted in its descent to scrotum during development)
    • smoking and high BMI increase risk for recurrence
27
Q

Describe the possible clinical features of an inguinal hernia

A
  • lump in groin that goes away with pressure or lying supine
  • mild to moderate discomfort (worse with activity)
    • beware: ~30% patients have no pain
28
Q

Indicate the most common location for the descent of a testis to be arrested in cryptorchidism.

A
  • inguinal canal
29
Q

Outline the reasons for the prompt treatment of an undescended testis

A
  • a malpositioned testis can lead to degenerative changes in as early as 2 years
    • the environment is too hot for sperm development and normal hormone production
    • this can lead to risk of infertility and testicular cancer
30
Q

Construct a table to compare the causes and clinical features of the following disorders: varicocele, hydrocele, testicular torsion.

A
31
Q

Discuss the classification of testicular cancer. Which age groups are typically affected by each sub-class?

A
  • Seminomas
    • carcinoma of seminiferous tubule (most common)
    • men aged 25-50
  • Non-seminomas
    • e.g. mixed germ cell tumour (different types of tissue)
    • more aggressive
    • men aged in 20s
32
Q

What aetiological factors have been linked to testicular cancer?

A
  • unknown aetiology
  • risk factors: family history and cryptorchidism
  • no association with wearing tight clothes, hot baths or sporting injuries to the testes
33
Q

Outline the possible clinical features of a testicular cancer.

A
  • Painless, testicular enlargement is a common first sign
  • Sensation of heaviness in the scrotum or a dull ache in the lower abdomen
  • 10% are asymptomatic at presentation
  • 10% present with symptoms of metastatic disease
    • back pain
    • cough
    • haemoptysis
    • dyspnoea
  • Secondary hydrocele (5-10% of cases)
  • Gynaecomastia (male breast enlargement) (5% of cases)
34
Q

Explain the role that you can play as an osteopath in the promotion of male reproductive health.

A
  • educate males on what signs or symptoms to look for in regards to testicular health
  • remove the stigma surrounding these disorders
  • recommend health services or websites for further investigation or information
  • testicular self-examination (still a hotly debated issue) - will it increase anxiety or lead to early detection of testicular cancer?

Osteopathy Y3S1 (11 decks)

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