Male Reproductive Pathophysiology

Question 1

Where is blood going to fill during an erection?

Answer 1

Corpus Colosseum

Question 2

What is a hypospadias?

Answer 2

Congenital anomaly –> ventral location of the urethral opening (androgen mediated)

Urethral groove forms inappropriately and does not close

Question 3

What are risk factors for hypospadias?

Answer 3

Preterm
Maternal Diabetes
Paternal history
Fetal Growth Restriction

Question 4

What is epispadias?

Answer 4

Urethra opening on the dorsal side of the penis

Question 5

What are paraphimosis?

Answer 5

Urologic Emergency!

Prepuce that has been retracted proximal to the glans - occurs when pt pulled prepuce back and not returned

Question 6

Why is paraphimosis an emergency?

Answer 6

Prepuce is going to act as a tourniquet which will lead to necrosis of the glans

Question 7

What is the presentation of paraphimosis?

Answer 7

Presents with pain, edematous prepuce, and shaft will be flaccid

Question 8

What is phimosis?

Answer 8

Prepuce is stuck over the glans of the penis

Unable to retract, can develop fibrous scar tissue ring

Question 9

What nerves are being stimulated causing an erection?

Answer 9

S-2, S-4

Question 10

Erections are controlled by what branch of the nervous system?

Answer 10

Parasympathetic

Question 11

Describe the normal erection physiology?

Answer 11

Ach acts directly on the vasculature to increase NO –> vasodilation

Erectile tissue will fill with blood –> venous drainage occluded

Detumescence occurs when there is a loss of NO

Question 12

Why are diabetics at an increased risk of erectile dysfunction?

Answer 12

Decreased NO synthase

Question 13

What are two conditions that will create issues with NO synthesis leading erectile dysfunction?

Answer 13

Atherosclerosis
DM

Question 14

What are some etiologies of erectile dysfunction?

Answer 14

Vascular
Neurologic
Local penile factors
Hormonal
Drug induced
Psychologic

Question 15

Is erectile dysfunction associated with cardiovascular disease?

Answer 15

Yes

Question 16

What is Peyronie’s Disease?

Answer 16

Fibrous deposition within the tunica albuginea of the corpora cavernosa

Palpable along dorsal aspect of the penis

Question 17

What is priapism?

Answer 17

Erection > 4 hours not associate with sexual stimulation

Question 18

Is priapism considered an emergency?

Answer 18

Yes, blood within the penis is going to clot (compartment syndrome of the penis)

Question 19

What are the low-flow causes of priapism?

Answer 19

• Decreased venous return
• Elevated pressure may lead to ischemia
• Medications, sickle cell

Question 20

What are the high-flow causes of priapism?

Answer 20

• Less common
• Associated with increased arterial inflow not balanced by venous outflow
• Less painful
• Associated with trauma

Question 21

When does the prostate stop rapidly growing?

Answer 21

Age 30

Question 22

Dihydrotestosterone is a metabolite of what?

Answer 22

Testosterone and metabolized by 5a-reductase

Question 23

What is prostatitis?

Answer 23

Inflammation of the prostate…its a big deal!

Starts off with similar symptoms of a UTI

Question 24

Prostatitis is an ascending infection typically associated with GI pathogens, what is the most common pathogen?

Answer 24

E. coli

Question 25

What is a hydrocele?

Answer 25

Tunica vaginalis envelops testis, folds on itself like fist in a balloon

Common in newborns

Question 26

Epididymitis is most commonly associated with

Answer 26

STI’s (gonorrhoeae and trachomatis)

Question 27

What are the risks of epididymitis?

Answer 27

abscess, infertility, infarction

Question 28

Orchitis is classically associated with what vaccine preventable infection?

Answer 28

Mumps

Question 29

Testicular torsion is a surgical emergency and requires intervention within how many hours of onset?

Answer 29

6 hours