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Pathophysiology 212 > Disorders of the male genitourinary system > Flashcards

Disorders of the male genitourinary system Flashcards

1
Q

Erectile Dysfunction (ED)

A 
- Inability to achieve and maintain erection sufficient topermit satisfactory sexual intercourse
Causes:
- Psychogenic
- Organic – most common
- Both
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2
Q

ED Etiology: Psychogenic

A
  • Performance anxiety
  • Emotional issues with partner
  • Depression
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3
Q

ED Etiology: Organic

A
  • Neurogenic – stroke, spinal cord injury, surgery
  • Vascular – hypertension, smoking, DM
  • Hormonal – decreased androgen levels

Drug-induced

  • Antihypertensives, nicotine, alcohol, antidepressants, antipsychotics, B-blockers
  • Aging
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4
Q

ED Treatment

A
  1. Psychosexual Counselling
  2. Medication
  3. Androgen replacement
  4. Oral Phosphodiesterase type 5 inhibitors
  5. Intracavernous (injection in penis)
  6. Prosthesis
  7. Vascular surgery
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5
Q

Penile Inflammation/Infection Cause & Manifestations

A
  • Due to trauma, irritation, infection
  • Candida albicans, bacteria
  • Often related to STIs

Manifestations
- erythema, edema of glans and prepuce
- Blanitis xerotica obliterans (often UKE):
Sclerosing atrophy of the foreskin in uncircumcised men: precancerous state

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6
Q

Priapism

A
  • Involuntary, prolonged, painful erection d/t impaired blood flow in corpus cavernosa resulting in failure of detumescence
    > Risk factors
  • Any age
  • Sickle cell disease, neoplasms
> Primary
> Secondary
- Hematological, neurological, renal
- Medications
if not resolved in 48hr: permanent sclerosis, fibrosis, necrosis
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7
Q

Testicular Torsion

A
  • Twisting of the spermatic cord suspending testes

- Extravaginal or Intravaginal

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8
Q

Testicular Torsion (cont)

A

Extravaginal: more common fetus/neonate

Intravaginal:

  • Common in teenager d/t testicular growth
  • Obstructs venous drainage first, then arterial
  • Edema, pain, nausea
  • Often second testes affected… or will be
  • Surgery: fixate testes or orchiedectomy (removal of testes)
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9
Q

Cryptorchidism and Risk Factors

A
  • Failure of one or both testicles to move down inguinal canal into scrotal sac by 7-9 months gestation
    > Risk factors
  • Prematurity, small birth weight, genetic if term-baby
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10
Q

Cryptorchidism (cont) Complications & Tx.

A
  • Spontaneously descends by 3 mo. but rarely after 4 mo.
  • Abnormal testicular pathology by 6-12 months

Complications
- Infertility, testicular torsion, malignancy (high rate), psychological
Treatment
- Surgery and follow-up screening

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11
Q

Prostatitis causes

A 
- infection of the prostate
Causes 
1. Spontaneous
2. instrumentation
3. Secondary 
- HIV
- DM
- urethral strictures
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12
Q

Types of Prostatitis

A
  1. Acute bacterial (UTI related)
  2. Chronic bacterial
  3. Chronic prostatitis/pelvic pain syndrome
    - Most common/least understood
    - Inflammatory but not bacterial, or non-inflammatory
  4. Asymptomatic inflammatory prostatitis
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13
Q

Acute Prostatitis

A
  • E. coli most common pathogen
    Manifestations (similar to pyelonephritis)
  • Fever, malaise
  • Dysruia, frequency
  • Pelvic aching pain (rectum, perineum)
  • Malodorous cloudy urine
  • Rectal exam: swollen, tender, warm, thick discharge
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14
Q

Benign Prostatic Hyperplasia (BPH)

A

> Non-malignant enlargement of prostate d/t imbalance between cell proliferation & apoptosis
- Common >60 years old

Related to

  • Proliferation of prostate cells
  • Alpha 2 adrenergic receptors overact
  • Detrusor instability & impaired bladder contractility (recent thoughts)
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15
Q

BHP Manifestations

A

Prostate enlargement compresses urethra causing
- Weak stream, urgency, dysuria, nocturia, overflow incontinence

Bladder distension causes destructive changes in bladder wall

  • hydroureter, Hydronephrosis, herniations
  • infection
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16
Q

BPH Treatment

A
  1. Pharmacologic
    - Alpha adrenergic blockers
    - Alpha reductase inhibitors block androgens
  2. Herbal therapies
  3. Surgery
    - Removal of enlargement
    - Transurethral prostatic resection (TUPR)
    - Suprapubic, perineal
    - Laser vaporization, microwave, needle ablation
17
Q

Prostatic Cancer

A
  • 2nd most frequently diagnosed cancer in men
  • Incident increases >50 years of age
  • Etiology (unclear)
    familial connection
    increased dietary fats may alter hormonal balance
18
Q

Prostate Ca Manifestations

A
  1. Asymptomatic initially
  2. Metastasis to lung reflects lymphatic spread
  3. Migration to bladder ot until later
  4. Bone pain (vertebral, rib, pelvis) often first sign d/t metastasis
19
Q

Prostatic Ca: Screening/Diagnosis & Treatment

A
  • Digital exam via rectum
  • Transrectal ultrasound
  • Prostatic Specific Antigen (PSA) ??
Treatment
- Surgery:
Radical Prostatectomy
- Radiation
- Hormonal therapy to reduce testosterone levels

Pathophysiology 212 (18 decks)

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