Male reproductive system pathologies Flashcards
(36 cards)
Function of Bulbourethral gland?
Production of pre - ejaculate.
0 Neutralists urine that may be in urethra.
0 located in membranous Urethra
What is the ejaculatory duct made up of ?
Pathway of semen?
duct from seminal vesicles + vans deferens from prostate
Pathway of semen
Ejaculatory duct ——> prostatic urethra ——> Membranous U——> Penile / spongy U —– > glans penis (semen leaves through this )
- Semen - mixture of sperm and accessory fluid.
Where does the majority of blood go to in penis during an erection ?
Why?
90 % to corpus cavernosa
10% to corpus spongiosum
(majority goes to cavernosa so that only little goes to spongiosum - this contain male urethra. too much blood will cause too much pressure build up and occlude urethra.
Function of cremaster and dartos muscle.
0 located in scrotum , smooth muscle
0 contact to elevate the testes - bring closer to belly during cold weather to retain heat.
What is the spermatic cord ?
Cord containing testicular vein, arteries and nerves.
0 formed at opening of inguinal canal ——> enters scrotum via supercritical inguinal canal
What is the rete testis ?
Astamosing network of the seminiferous tubules in the testes - help with the transfer of sperm.
(seminiferous tubules join to form this network)
What are the possible cause of lump in testes ?
0 Hydrocele 0 indirect / scrotal hernia 0 Varicocele 0 Epididymitis 0 Epdidymal cyst 0 Tumour
What is a hydrocele ?
Painless swelling of scrotum
Common in newborns
collection of fluid between parietal and visceral layers of tunica vaginalis.
Can be : - non -communicating (isolated) - communicating (connects to abdominal cavity through potential hernia space - patent processus vaginalis )
hydrocele ofen get better on their own
surgical intervention 0 may be required for communicating hydroceles to close channel
What is epididymitis ?
inflammation of the epididymis
Characterised by :
unilateral scrotal pain
unilateral scrotal swelling
Causes
Bacterial epidymitis
0 <35 - most commonly sexually transmitted diseases (Neisseria gonorrhoeae or Chlamydia trachomatis) - can start as urethritis (infection of urethra).
0 > 35 - most commonly occur in urological abnormalities , indwelling catheters or recent urological procedures.
Other causes - rare except for in immunocompromised patients (HIV - infected patients )
Tuberculous epididymitis and syphilitic gummas
(bacteria infections )
Viral causes - Cytomegalovirus
Mycotic causes - (fungal causes )
What is an epididymal cyst ?
- Fluid filled sac - benign
0 Grows at top end of testicle (where spermatic cord is attached )
0 can be small or large - can grow to size of testes.
0 can be one or several on both testicles.
0 is felt separate from testicle (unlike testicular cancers)
SYMPTOMS
- pain free , lump at top of testicles , separate from testes.
- small cyst do not need treatment. Larger ones may need surgery or needle aspiration (not common)
- More common in men above 40
- spermatocele - can feel the same but is a cyst filled with sperm.
What is a varicocele ?
collection of varicose veins of the small vein near one or both testicles.
varicose
veins in
scrotum -
abnormal
dilation/
enlargement
of scrotal
venous
pampiniform
plexus -
drains from
each testicle.
0 Can happen above beside one or both testicles.
- Caused by weakening of valves so venous blood flow backwards
RARE CAUSES
0 Deep vein thrombosis
0 renal arteriovenous malformations
0 thrombosis of the pampiniform plexus.
- Can be felt as a bag of worms in scrotum.
- if man is over 40 and suddenly get varicocele - could be cancer (tumor in kidney adds back pressure - on smaller veins in scrotum.
What is testicular cancer ?
Cancerous
rare -not common but have to be on the look out.
- effect men between 15 and 49 most commonly.
SYMPTOMS
Felt as :
- painless swelling lump -usually 1
- Dull ache / sharp pain in testicles/ scrotum
- Heaviness in scrotum
- Testis loses normal shape - larger, irregular and bumpy.
Most lumps or swellings in the scrotum are not in the testicle and are not a sign of cancer, but they should never be ignored
- men whose testes did not descend into the scrotum (cryptorchidism) by age 3 have a greater chance of developing testicular cancer.
0 Correcting cryptochidism can decrease risk of this cancer - but still higher than normal. - Metastic cancer - spread to other parts of the body causing other symptoms.
What is an scrotal hernia ?
Can also be called indirect hernia
Appears as a swelling / lump in groin or as enlarged scrotum.
Hernia - structure passes through a space or defect into an
abnormal location.
inguinal hernia - most common
0 protrusion of abdominal contents through acquired or congenital area of weakness /defect in abdominal wall just above inguinal ligament.
Symptoms
- visible bulge
- discomfort
- can be asymptomatic
findins - cannot rise above it affects spermatic cord.
Causes :
0 increased intra - abdominal
0 weakness in abdominal muscles
These can be caused by - chronic cough - constipation -obesity - heavy lifting advanced age.
Direct vs indirect hernia ?
Direct - abdominal contents passes through defect (abnormal opening) in posterior inguinal canal wall ——-> into inguinal canal (medial to deep ring )—–> out of superficial inguinal ring.
INDIRECT
Abdominal contents passes through deep ring —> inguinal canal —–> out via superficial
ring.
Clinical test to differentiate :
Indirect - press on deep ring (mid line of inguinal ligament) - you can control the indirect hernia which has been reduced
Direct - same thing is done, but hernia still protrudes indicates it is merging through posterior inguinal wall defect.
Meaning of these terms relating to hernias.
- reducible
- incarcerated
- obstructed
- strangulated
Reducible - hernia contents can be manipulated back into original position (returned to it original compartment through defect that it emerged through. ) - can provide symptom relief
Incarcerated / irreducible - Cannot be pushed back into original position / compartment,- due to compression of hernia by defect.
Obstructed - relates mainly to hernias containing bowel - hernia containing bowel compressed so bowel obstruction occurs
bowel lumen not patent (open - unobstructed )
Strangulated - lack of blood flow to hernia contents due to compression around the hernia - causes ischemia and pain.
Management of suspected inguinal hernia
- Exclude strangulated or obstructed hernias.
0 If present admit to hospital immediately .0 if not
present :
- Infant / young boy - refer urgently to paediatric surgeon .
- men /
older boys
-urgent referral for
surgical repair - if irreducible or partially reducible
Refer all others routinely for surgical repair, unless they have :
0 minimally symptomatic inguinal hernias \+ 0 significant comorbidity \+ 0 do not want to have surgery.
Treatment of inguinal hernia ?
Inguinal hernia repair
Laparoscopic surgery /keyhole
-0 3 small incision made allowing various instrument to enter through one hole and repair hernia
(includes laparoscope - light & camera inserted through incision - through the other holes)
Open surgery - Cut made to allow surgery to push lump back into abdomen . Mesh is used to reinforce area of weakness where hernia came through
- if area of bowel is strangulated - needs to removed and healthy 2 ends joined.
primary single sided hernia - open surgery recommended .
recurrent or bilateral hernias - keyhole surgery recommended.
What are the 2 types of Keyhole surgery ?
Transabdominal preperitoneal (TAPP)
- insertion of instruments through abdominal wall & peritoneum (lining covering organs)
- Flap of peritoneum then pulled over hernia and reinforced with mesh.
Totally extraperitoneal (TEP)
- repair of hernia without entering peritoneal cavity. incisions stitched or sealed with surgical glue.
These procedures should only be performed by surgeons who regularly carry out procedure.
Management of Testicular cancer ?
Refer urgently to urologist, to be seen within 2 weeks.
Consider measuring tumour markers whilst waiting :
0 Human chorionic gonadotrophin (hCG) levels.
0 AFP - Alpha fetoprotein levels
What AFP ?
AFP levels - tumour marker for cancer of testis
Normal adult ranges - 0 to 10 IU/ml
Alpha-fetoprotein (AFP) levels. 0 ( protein produced by liver in developing baby - high but fall by age 1. healthy adults adults - low levels.
0 AFP - made by cancer cells or by normal cells in response to cancer.
- High level suggest possible cancer but not always
high level don’t always mean cancer , normal levels don’t exclude cancer. Used in conjunction with other methods t screen for cancer.
*can be used to check effectiveness of treatment.
(Go higher - cancer spreading
Go lower - treatment working.
What is hCG?
Human chorionic gonadotropin - beta subunit HCG
- used a tumour marker
- Not present in normal men
- presence indicates cancer.
- can be used to determine the effectiveness of cancer therapy.
Treatment of testicular cancer ?
orchidectomy - removal of a testicle(plus attached Blood vessels)
(some cases only a part is removed)
(orchido - testicles )
(ectomy - removal )
- Artificial one out of silicone inserted for appearance.
Higher chance of recovery - ability to father children and sex life not affected.
0 bilateral orchidectomy removal of both testes - infertile. (can bank sperm if plan to have children in future)
- may be only treatment needed if cancer found early)
- Lymph node and lung surgery - if cancer spread lymph nodes need to be removed - most likely tummy ones.
- damage to nerves around lymph node can lead to retrograde ejaculation.
What is retrograde ejaculation?
Semen travels backwards to bladder instead of through urethra.
CAUSES
damage to nerves and muscles around bladder.
Muscles usually tightly closer around bladder neck at time of orgasm. Damage means this does not happen.
SYMPTOMS
0 produce no semen
0 Cloudy urine - semen in it when you fist go to toilet after having sex.
TREATMENT
0 Usually no treatment required - still have a healthy sex life and lack of adverse health effects.
0 pseudoephedrine (commonly used as a decongestant) - for retrograde ejaculation caused by surgery of diabetes
0 can be caused by prescribed medicine - stopping will stop problem.
0 extensive - treatment may not be possible
What are the ejaculation issues ?
0 premature ejaculation - ejaculate too quickly during intercourse.
CAUSES
many :
physical - prostate , thyroid problems and recreational drug use.
Physchological - depression , stress, anxiety aboiut sex etc.
Treatment - does need to if couple happy with it. but can seek treatment :
SSRI - Selective serotonin inhibitors - treat depression but delay ejaculation also.
0 paroxetine
0 sertraline
0 fluoxetine
0 * Daproxetine - specially made SSRI to treat premature ejaculation. -
0 Delayed ejaculation
0 Retrograde ejaculation
