Male- Genitourinary Disease

Question 1

The genitourinary system consists of: (Five parts)

Answer 1

1. Bladder
2. Prostate
3. Penis
4. Urethra
5. Testis

Question 2

Hypospadias and Epispadias are what kind of penile malformation? Which of these is more common?

Answer 2

Abnormal location of the distal urethral orifice
Hypospadias = ventral (more common)
Epispadias = dorsal

Question 3

Both hypospadias and epispadias increase the prevalence of ________ infections.

Answer 3

urinary tract

Question 4

What is the most common type of penile neoplasm?

Answer 4

Squamous cell carcinoma and its precursor

make up 0.4% of all male cancers; so it’s still rare, but is the most common penile neoplasm

Question 5

Squamous Cell Carcinoma is most common in ________ men and is associated with _____ infection.

Answer 5

uncircumcised (greater than 40)

HPV

Question 6

Penile neoplasms are often preceded by ________.

Answer 6

premalignant lesions (red/white plaque)

Question 7

What is the other name for carcinoma in-situ?

Answer 7

Bowen Disease

only about 20% will progress to cancer

Question 8

True or False: Distant metastases are relatively common in squamous cell carcinoma of the penis.

Answer 8

False, uncommon

Question 9

The 5 year survival rate for localized penile squamous cell carcinoma is ______%.

Answer 9

66

Question 10

To which nodes will penile neoplasms typically metastasize?

Answer 10

inguinal

Question 11

What was the first human cancer that was found to be associated with occupational factors?

Answer 11

scrotal squamous cell carcinoma (chimney sweeps)

Question 12

_______ is the incomplete descent of the testis from the abdomen to the scrotum.

Answer 12

Cryptorchidism

Question 13

When do the testis normally descend from the abdomen?

Answer 13

into the pelvis = by the third month of gestation

into the scrotum = during last two months intrauterine

Question 14

Can cryptorchidism result in sterility?

Answer 14

Yes, both in the case of uni- and bilateral

Question 15

How common is cryptorchidism in 1 year old males?

Answer 15

1%

Question 16

Crytorchidism results in a ____fold increased risk for testicular cancer.

Answer 16

3 to 5

Question 17

______ is the procedure used to treat cryptorchidism and therefore reduce the risk of sterility or cancer.

Answer 17

Orchiopexy (pull ‘em back down)

Question 18

Inflammatory lesions of the testis are more common in _______ than ________.

Answer 18

epididymis (epididymitis)
testis proper (orchitis)

Question 19

Inflammatory lesions of the testis can be the result of complications from _______, ______, or _____.

Answer 19

urinary tract infections
mumps in adults (>20years old= 25% chance of lesion)
STDs

Question 20

What is torsion? What are the two types?

Answer 20

twisting of the spermatic cord that causes obstruction of venous drainage and results in RAPID, INTENSE, vascular engorgement

1. Tunica Vaginalis
2. Bell Clapper

Question 21

“partial enclosure with tie off at the gubernaculum” describes which type of torsion?

Answer 21

Tunica Vaginalis

Question 22

“testis is inadequately affixed to the scrotum allowing it to move freely on its axis and is susceptible to induced twisting of the cord and its vessels” describes which type of torsion?

Answer 22

Bell Clapper

Question 23

Testicular neoplasms occur in ______ out of 100,000 males with a peak incidence of _____ years old.

Answer 23

6

15-34 years old

Question 24

What is the most common cause of painless testicular enlargement?

Answer 24

Testicular neoplasms

Question 25

Which type of cell typically causes testicular neoplasms to be malignant? Which cell type is related to benign tumors?

Answer 25

Germ Cells = malignant | Sex-cord-Stromal cells = benign

Question 26

Of the testicular neoplasms, what percentage are sex-cord-stromal tumors and germ-cell tumors?

Answer 26

``` Germ = 95% Sex-Cord-Stromal = 5% ```

Question 27

Germ cell tumors (which account for 95% of testicular neoplasms), are divided into what two groups?

Answer 27

1. Seminomas | 2. Non-seminomatous tumors

Question 28

Histologic appearance of germ cell tumors can be pure (single cell type) or will often be ______.

Answer 28

mixed (multiple cell types)

Question 29

_____ are germ cell tumors that arise from epithelium of the seminiferous tubules.

Answer 29

seminomas

Question 30

True or False: Seminomas respond well to chemotherapy due to radiosensitivity and therefore are one of the most curable cancers.

Answer 30

True

Question 31

Non-seminomatous tumors (germ cell tumor type) will tend to spread early via _____ and _______.

Answer 31

lymphatics blood vessels (even small tumors may present with extensive metastases to liver and lung)

Question 32

What are the tumor markers used to detect Non-seminomatous tumors?

Answer 32

1. alpha-fetoprotein (AFP) | 2. Human Chorionic gonadoropin (hCG)

Question 33

Which type of germ cell tumor is characterized as "well-circumscribed with a high nucleus:cytoplasm ratio?"

Answer 33

Seminoma

Question 34

There are _____ new cases of germ cell tumors annually in the U.S.

Answer 34

8,000 | less than 400 deaths

Question 35

____% of early-stage seminomas are cured. _____% of patients with nonseminomatous tumors achieve remisison with chemotherapy, most are cured.

Answer 35

95 90 (choriocarcinoma is the exception)

Question 36

Pure choriocarcinoma have a _____ prognosis than other germ cell tumors.

Answer 36

worse (distal disseminated infection)

Question 37

What are the three categories of prostate disorders?

Answer 37

1. inflammatory lesions 2. nodular hyperplasia 3. carcinoma

Question 38

Prostate hyperplasia begins in the ______ zone.

Answer 38

transitional (tz)

Question 39

In which zone of the prostate can carcinomas be felt via digital palpation?

Answer 39

peripheral zone (pz)

Question 40

True or False: The majority of men will have some form of prostate hyperplasia by the age of 50-60.

Answer 40

True

Question 41

What is prostatitis?

Answer 41

prostate enlargement and tenderness that leads to dysuria, increased frequency, and low back or pelvic pain

Question 42

Prostatitis can be associated with _____ (minority of cases) or can be _______ (most cases).

Answer 42

``` UTI infection (often e.coli) nonbacterial prostatitis (most cases) ```

Question 43

True or False: Nonbacterial prostatitis has an unknown etiology and shows no response to antibiotics.

Answer 43

True | aka: Chronic Pelvic Pain Syndrome

Question 44

Nodular Hyperplasia of the Prostate, aka ________, generally affects the _____ periurethral zone of the prostate and compresses the prostatic urethra.

Answer 44

Benign Prostatic Hyperplasia (BPH) | inner

Question 45

Benign Prostatic Hyperplasia (nodular hyperplasia) is the proliferation of ____ and _____ cells that results in enlargement and possible urinary obstruction.

Answer 45

stromal | glandular

Question 46

True or False: Nodular Hyperplasia is extremely common.

Answer 46

True, 20% of men by age 40 90% of men by age 70

Question 47

What are the clinical symptoms of nodular hyperplasia?

Answer 47

hesitancy urgency nocturia poor urinary stream

Question 48

One theory for the development of nodular hyperplasia is the local increase in _____.

Answer 48

androgens (hormonal stimulus)

Question 49

What is the treatment for nodular hyperplasia?

Answer 49

1. Medical Management (drug treatment) | 2. Surgical Management (TURP)

Question 50

What is TURP?

Answer 50

transurethral resection of the prostate (small pieces of tissue are cut from inside the prostate)

Question 51

What is the most common cancer of men over age 50 in the U.S.?

Answer 51

adenocarcinoma (accounts for 25% of cancer but only 9% of cancer deaths)

Question 52

Free movement of cells through the _____ plexus allows metastasis of adenocarcinoma from the genitourinary system to other parts of the skeleton (ex. the mandible mimicking PA lesion)

Answer 52

paravertebral

Question 53

Carcinoma of the prostate most commonly arises from the the ______ glands.

Answer 53

outer (peripheral) | = allows them to be palpable during digital exam

Question 54

Carcinoma of the prostate causes an elevated serum __________ level, but elevated levels could be due to other conditions as well.

Answer 54

prostate specific antigen (PSA)

Question 55

What is the treatment for carcinoma of the prostate?

Answer 55

combination therapy: - surgery - radiation - hormonal

Question 56

The prognosis for Prostate Carcinoma is ______% overall 10 year survival or ______% 10 year survival if disseminated.

Answer 56

98% | 30%

Question 57

The majority (90%) of bladder cancers are _________

Answer 57

urothelial carcinoma

Question 58

How can bladder cancer be measured/detected?

Answer 58

tumor cells shed into the urine and can be detected via cytology

Question 59

In which portion of the population is bladder cancer most common?

Answer 59

men age 60-80 years

Question 60

What are the risk factors that contribute to bladder cancer occurrence?

Answer 60

cigarette smoking chronic cystitis infections with schistosomiasis exposure to carcinogens

Question 61

Bladder (urothelial) cancer can begin as ______ carcinoma or _____carcinoma. Both have potential to become invasive

Answer 61

papilloma-papillary (looks like "coral") | flat

Question 62

Urothelial cancer is treated via _______ or _____ or (less effectively) by ______. What is the prognosis?

Answer 62

transurethral resection radical cystectomy immunotherapy prognosis depends on tumor grade and stage