Class 5 chapter 39

Question 1

Erectile Dysfunction

Answer 1

Inability to achieve and maintain erection sufficient to permit satisfactory sexual intercourse

Question 2

Erectile Dysfunction causes

Answer 2

Psychogenic
Organic – most common
Both

Question 3

Psychogenic erectile dysfunction

Answer 3

Performance anxiety
Emotional issues with partner
Depression

Question 4

Organic erectile dysfunction

Answer 4

1. Neurogenic (Stroke, spinal cord injury, surgery)
2. Vascular (Hypertension, smoking, DM)
3. Hormonal (Decreased androgen levels)
   4 Drug-induced (Antihypertensives, nicotine, alcohol, antidepressants, antipsychotics, B-blockers)
   Aging

Question 5

Erectile dysfunction treatment

Answer 5

Psychosexual Counselling
Medication (Androgen replacement, Oral Phosphodiesterase type 5 inhibitors, Intracavernous - injections in penis itself to increase blood flow and maintain erection)
Prosthesis
Vascular surgery

Question 6

Penile Inflammation/Infection

Answer 6

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

Question 7

Penile Inflammation/Infection manifestations

Answer 7

Erythema, edema of glans and prepuce
Malodorous discharge
Blanitis xerotica obliterans (uncircumsized, foreskin becomes sclerosed, precursor to cancer)

Question 8

Priapism

Answer 8

Involuntary, prolonged, painful erection d/t impaired blood flow in corpus cavernosa resulting in failure of detumescence

Question 9

Priapism risk factors

Answer 9

Any age

Sickle cell disease, neoplasms

Question 10

Priapism types

Answer 10

1. Primary 
Happens without cause
2. Secondary 
Hematological, neurological, renal
Medications

Question 11

Testicular Torsion

Answer 11

Twisting of the spermatic cord suspending testes

Extravaginal or Intravaginal

Question 12

Extravaginal Testicular Torsion

Answer 12

More common fetus/neonate

Question 13

Intravaginal Testicular Torsion

Answer 13

Emergency as in tunica vaginalis
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)

Question 14

Cryptorchidism

Answer 14

Failure of one or both testicles to move down inguinal canal into scrotal sac by 7-9 months gestation
Spontaneously descends by 3 months but rarely after 4 months
Abnormal testicular pathology by 6-12 months

Question 15

Cryptorchidism risk factors

Answer 15

Prematurity, small birth weight, genetic if term-baby

Question 16

Cryptorchidism complications

Answer 16

Infertility, testicular torsion, malignancy (high rate), psychological

Question 17

Cryptorchidism treatment

Answer 17

Surgery and follow-up screening

Question 18

Prostatitis causes

Answer 18

Spontaneous
Instrumentation
Secondary (HIV, DM, urethral strictures)

Question 19

Prostatitis types

Answer 19

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

Question 20

Acute Prostatitis

Answer 20

E. coli most common pathogen

Question 21

Acute Prostatitis manifestations

Answer 21

Fever, malaise
Dysuria, frequency
Pelvic aching pain (rectum, perineum)
Malodorous cloudy urine 
Rectal exam – swollen, tender, warm, thick discharge

Question 22

Benign Prostatic Hyperplasia (BPH)

Answer 22

Non-malignant enlargement of prostate d/t imbalance between cell proliferation and apoptosis
Common >60 years old
RELATED TO
- Proliferation of prostate cells
- Alpha 2 adrenergic receptors overact
- Detrusor instability & impaired bladder contractility (recent thoughts)

Question 23

BHP Manifestations

Answer 23

Prostate enlargement compresses urethra causing (Weak stream, urgency, dysuria, nocturia, overflow incontinence)
Bladder distension causes destructive changes in bladder wall (Hydroureter - more urine in ureter, hydronephrosis -more urine in kidneys, herniations
Infection)

Question 24

BPH Treatment

Answer 24

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

Question 25

Prostatic Cancer

Answer 25

2nd most frequently diagnosed cancer in men Incident increases >50 years of age Etiology (unclear) - Familial connection - Increased dietary fats may alter hormonal balance

Question 26

Prostatic Cancer manifestations

Answer 26

Asymptomatic initially Metastasis to lung reflects lymphatic spread Migration to bladder not until later Bone pain (vertebral, rib, pelvis) often first sign d/t metastasis

Question 27

Prostatic Cancer screening diagnosis

Answer 27

Digital exam via rectum Transrectal ultrasound Prostatic Specific Antigen

Question 28

Prostatic Cancer treatment

Answer 28

Surgery Radical Prostatectomy Radiation Hormonal therapy to reduce testosterone levels (Testosterone increases growth of tumour in prostate so tries to reduce)