Topic 11 - Urinary system II (male)

Question 1

What are the 2 parts of the urinary system & are they the same of different in male/females?

Answer 1

• Upper urinary tract = same
• Lower urinary tract = different

Question 2

What does the bladder do?

Answer 2

It stores urine until need to go to bathroom & then the muscles contract

Question 3

What are the differences in the lower tract for females & males?

Answer 3

Urethra:
- Females = shorter & located internally
- Males = longer, located in penis (external) & have prostate (F’s X)

Question 4

What are some common bladder disorders?

Answer 4

• Urinary incontinence (UTI’s)
• Cystitis (inflamed bladder)
• Overactive bladder (squeeze urine out wrong time)
• Interstitial cystitis (chronic causing bladder pain & frequent/urgent urination)

Question 5

What is the function of the prostate?

Answer 5

Facilitates fertilisation by increase sperm motility & provide nourishment via expulsion of fluid into urethra

Question 6

What are the 4 main fluid constituents?

Answer 6

1. Proteolytic enzymes
2. Acid phosphatase
3. Zinc
4. Citric acid

Question 7

What are the type of epithelial cells lining the prostate?

Answer 7

Secretory epithelial cells which secrete fluid into ducts & stored

Question 8

How is semen formed?

Answer 8

1. Smooth muscle surrounding ducts (sympathetic nerves) release NA to mediate contraction of prostate smooth muscle (adrenoreceptors)
2. Prior ejaculation, sympathetic nerves release NA
3. Contraction of prostate -> prostatic secretions squeezed out of gland
4. Moves into urethra where it mixes with sperm & seminal fluids
5. This forms semen

Question 9

What is BPH?

Answer 9

• BPH = Benign Prostatic Hyperplasia
• Is where the prostate is enlarged

Affects:
50% men in 50s
90% men in 80s

Question 10

How does the prostate enlarge?

Answer 10

• Prostate grows inwards not outwards (no space)
• This put pressure & constricts urethra
• Severity is on how hard/tone of prostate

Question 11

What are the 3 major types of adrenoreceptors?

Answer 11

a1 (a1A, a1B, a1D), a2 & B

(alpha & beta)

*NOTE: S.M on prostate have high a1A vs vascular has high a1B & a1D

Question 12

How to manage mild-moderate symptoms of BPH?

Answer 12

• X-specif. med = a1B adrenoreceptors e.g prazosin -> SIDE EFFECTS: weakness, fatigue, dizziness & postural hypotension (good if BP high)
• uroselective = selective a1A antagonists as a1A more specif. to prostate S.M vs vascular S.M e.g tamsulosin (Flomax)
• Steroid 5a-reductase inhibitors = prevent conversion of testosterone to DHT (dihydrotestosterone) as DHT enables prostate growth thus inhibitors prevent growth -> SIDE EFFECTS: erectile dysfunction, libido loss, ejac disorders

Question 13

How do you treat severe BPH (4)?

Answer 13

• TURP (Transurethral resection of prostate) = invasive process where needle goes into urethra to make more space for urine to pass through -> SIDE EFFECTS: Retrograde ejac (75%), erectile dysfunction (10%) & Incontinence (1%) - MULTIPLE TIME
• Radical proctectomy = removal of entire prostate, norm for cancer treatment but also VERY large prostates -> SIDE EFFECTS: Erectile dysfunction (85%) & Incontinence (5%)
• TUNA (Transurethral needle ablation) = Radiofrequency needle put in urethra & heat-induced necrosis -> SIDE EFFECTS: Low chance incontinence/erectile dysfunction
• TUMT (Transurethral microwave therapy) = catheter inserted into bladder & microwave antenna in prostate & destroy hyperplastic prostate tissue - ONE TIME ONLY