Class 23 Pt. 3 - Alterations in Reproduction, Structural

Question 1

Hypospadias

Answer 1

When the urethra, instead of the opening on the central part of the glans, tends to open on the undersurface of the penis

• Congenital
• Relatively common 1/300 boys have some degree of hypospadias

Risk factors

• Maternal age
• Associated to exposure to progestin and other unknown environmental factors

Can easily be repaired with surgery depending on how serious or how harmful it is

Question 2

Epispadias

Answer 2

There is an opening on the upper surface of the penis, or an absolute defect in the formation of the urethral groove

• Congenital
• Can occur in females (less common)
• Can project all the way to the bottom of the bladder; incontinence

Question 3

Phimosis

Answer 3

Foreskin is too tight to move backwards over the glans

• Physiological or pathological cause
• Treatment: circumcision

Question 4

Paraphimosis

Answer 4

Foreskin cannot be moved back forward over the glans once it has been pushed backward

• Physiological or pathological cause
• Can cause edema and necrosis of the glans if not corrected
• Important to move foreskin back over the top
• Treatment: circumcision

Question 5

Varicocele

Answer 5

Abnormal dilation of veins in the spermatic cord

• Usually due to congenital incompetence of the valves in those veins
• Backflow pressure - decreased blood flow to the testes - decreased spermatogenesis - infertility

Question 6

Hydrocele

Answer 6

Collection of fluid in the outermost layer of the testes

• Can be congenital (if so, usually resolves on its own after the first year)
• Acquired anytime; can be associated with trauma, infection or tumours
• Can achieve large sizes - difficult to move around

Question 7

Cryptorchidism

Answer 7

Undescended testes

• Testes remain stuck in the abdominal cavity in the inguinal canal and fails to descend into the scrotum
• Unilaterally or bilaterally

Physical assessment

• Palpate the scrotum of the newborn to make sure they are in the scrotum at birth
• If is it not there, usually descends on own by age 1

Left untreated

• Infertility
• Increased rate of cancer of the testes

Treatment

• Hormonal therapy (small amounts will allow it to come down on its own)
• If not down by age 2, surgery

Question 8

Torsion of the Testes

Answer 8

Testes rotate on itslef and along with the rotation of the testicular artery and veins too

• Cuts off blood supply to the testes, causing what is called acute scrotum
• emergency situation involving manual reduction or surgery
• More common in newborns or adolescents
• Can occur spontaneously or after vigorous physical activity or trauma

Manifestations

• Pain and swelling
• Ischemia can lead to permanent damage and necrosis of the testes

Question 9

Cystocele

Answer 9

Occurs when the wall between a woman’s bladder and her vagina weakens and allows the bladder to droop into the vagina

Question 10

Cysourethocele

Answer 10

Drooping of the bladder and the urethra into the vagina

Question 11

Urethrocele

Answer 11

Drooping of the urethra into the vagina

Question 12

Rectocele

Answer 12

Rectum bulging into the vagina

- Causes problems with defecation

Question 13

Uterine Prolapse

Answer 13

Descent of the cervix and sometime the entire uterus into the vaginal canal

Mild: pessary can be used (round ring that is fit up around the neck of the cervix and elevates the uterus to keep it in place)

Severe: hysterectomy

Kegel exercises help strengthen the muscles of the pelvic region and the vaginal wall

• Women encourage to start Kegel exercises very early on in life to prevent this compliccation
• Avoid constipation and straining
• Surgery to re-anchor the bladder, uterus or to remove the uterus

Question 14

Ammenorrhea

Answer 14

Absence of a menstrual cycle

Primary

• No menstrual cycle before 14 along with no secondary sex characteristics or no menstrual cycle before 16 regardless
• Can be associated with congenital defect in gonadotropin production or genetic defects such as Turner’s syndrome

Secondary

• The absence of three or more menstrual cycles once a women has established her periods
• Often associated with starvation, psychogenic disturbances, extreme exercise, tumorus
• Can be associated with certain medical treatments such as chemotherapy
• If the cause is treated - menstrual cycle returns

Question 15

Dysmenorrhea

Answer 15

Painful periods

Primary: results primarily from an excess in prostaglandins in the endometrium

• Increased myometrial contractions and constriction of the endometrial blood vessels
• Results in pain an can be associated with headache, Gi upset, and fainting
• 50-75% of women between 15-25 are affected by some degree of primary dysmenorrhea
• Incidence seems to increase after mid 20’s
• Taking birth control seems to decrase the pain

Secondary: associated with a number of other diseases

• Endometriosis or PID
• Associated with adhesion and uterine fibroids

Question 16

Endometriosis

Answer 16

Functional endometrial tissue ends up in the peritoneal areas, and the fallopian tubes

• Endometrial tissue starts to respond to the hormonal fluctuations during the menstrual cycle
• this tissue therefore grows, breaks down and bleeds
• There are found in the abdominal or pelvic cavity (unusual) which sets off inflammation and pain which can lead to scarring, adhesions, and eventually infertility
• Up to 1/3 women who suffer from this are infertile

Question 17

Menopause

Answer 17

Cessation of menstrual cycles and considered a normal developmental change

• Most women stop between 48-55
• Perimenopause precedes menopause by an average of 4 years or so; irregular periods and other menopausal symptoms such as hot flashes
• A woman who has not had her period for a year and has elevated FSH and LH is considered to be menopausal
• Changes related to decrease in ovarian hormone secretion: hot flashes (vaso-motor flashes), regression of the tissues of the breasts, ovaries, and genitourinary tract structures; bone mass is lost
• Perimenopause stage: Increased risk fo coronary artery disease and other cardiovascular problems

Question 18

Andropause

Answer 18

Adrogen deficiency due to testicular failure or changes in the hypothalamus or pituitary glands

• Occurs in 1/200 men
• Decreased sex drive, erectile and ejaculatory capacity, atrophy of testes
• Associated with decrease in muscle mass