GU Pathophys

Question 1

penis anatomy

Answer 1

• Glans: head of the penis
• Urethra: tube located inside the penis that runs from the bladder to the head of the penis, crosses through the prostate gland
• Meatus: opening at the tip of the glans where urine or semen exit the body
• Prepuce: foreskin; loose fold of skin that covers the head of the penis, removal of the foreskin is circumcision
• Corpus Cavernosa: 2 columns of spongy tissue that run along the interior shaft of the penis; When filled with blood, tissue stiffen, and this causes the erection
• Corpus spongiosum: the third column of tissue that prevents the urethra from closing during an erection

Question 2

testicle anatomy

Answer 2

• Testes: also called testicles that produce and store sperm
• Scrotum: Sac of skin that contain the testes
• Seminiferous tubules: coiled tubes that make up most of each testis that are responsible for spermatogenesis
• Sertoli cells: part of the epithelium cells that line the seminiferous tubules that aid in the production of hormones that produce sperm
• Leydig cells: tissue next to the seminiferous tubules that produce male hormones such as testosterone and other androgens
• Vas deferens: “ductus deferens or sperm duct” that runs from the epididymitis and connects to the urethra through the ejaculatory duct
• Rete testis: sperm cells travel toward the epididymis through this structure
• Efferent ducts: series of tubes that join the rete testis to the epididymis that absorb most of the fluid that helps to move sperm cells
• Epididymis: structure that stores sperm until they are mature

Question 3

Male- layers of testes

Answer 3

Testes are surrounded by several layers of tissue:
* Tunica vasculosa: first thin layer of blood vessels
* Tunica albuginea: thick protective layer to protect the testes
* Tunica vaginalis: made up of three layers to further protect the testes

Question 4

Hydrocele

etiologies

Answer 4

• Idiopathic: most common
• Inflammatory: acute reactive hydrocele can occur w/ inflammatory conditions

Question 5

Hydrocele

types

Answer 5

• Communicating: peritoneal/abd fluid enters scrotum via patent processus vaginalis that failed to close
• Non-Communicating: derived from fluid from the mesothelial lining of the tunica vaginalis (no connection to peritoneum)

Question 6

priapism- types

Answer 6

• Ischemic (low flow): decreased venous outflow may lead to compartment syndrome leading to acidosis and hypoxia in the cavernous tissues (most common type; painful/rigid errection)
• Non-Ischemic (high flow): increased arterial inflow due to a fistula between the cavernosal artery and corpus cavernosum (commonly due to perineal or penile trauma; less painful & not fully rigid)

Question 7

priapism- etiologies

Answer 7

• idiopathic (50%)
• Sickle Cell Disease (10%)
• use of injectile agent (for ED, drugs [cocaine, marijuana], EtOH)
• trauma causing rupture of cavernosal artery
• meds (PDE-5 inhibitors, trazadone, anti-psychs, anti-convulsants, alpha blockers), and neurologic conditions (head trauma, meningitis, subarachnoid hemorrhage, post-op)

Question 8

Testicular Cancers- Prognosis

Answer 8

Very curable, high survival rate if treated appropriately
5-year survival rate of 95%
* Large majority of patients relapse withing the first 2 years of treatment completion
* Testicular examination by a clinician is recommended for men with a history of contralateral testicular cancer

Men who live for 2 years after diagnosis without relapsing have a high probability of being cured and very low risk of dying of the cancer

Question 9

Horseshoe Kidney

anat/phys

Answer 9

• renal fusion when a portion of one kidney is fused to the other due to abnormal migration of kidneys; horseshoe most commonly is each pole fused together
• isthmus lies in the mid-line or sometimes slightly lateral to the mid-line and can be composed of renal parenchyma or just fibrous tissue, but the renal collecting systems remain separate

Anatomy
* fusion occurs before the kidneys ascend from the pelvis to their normal dorsolumbar position (5th-9th wks gestation)
* fusion abnormalities found in lower lumbar vertebral level (L4/5)
* blood supply variable

Question 10

prostate gland anatomy/physio

Answer 10

• Walnut-sized structure in males that is primarily composed of glandular tissue
• Positioned inferior to the bladder and surrounds the superior portion of the urethra
• Primary function is to secrete a weakly acidic fluid that nourishes and transports sperm
• Semen = sperm + seminal fluid
• Prostate specific antigen (PSA) is secreted within the seminal fluid and can pass into the blood
• avg dimensions: 3cm long, 4 cm wide, 2 cm deep (AP depth)

Question 11

prostate zones

Answer 11

Peripheral Zone
* 70% of prostate gland
* responsible for 70% of prostate cancers
* closest to rectum

Central Zone
* 15-20% of prostate cancers
* surrounds ejaculatory ducts

Transitional Zone
* 10-15% of prostate cancers
* surrounds proximal urethra
* key area of concern for BPH

Fibromuscular Zone
* cancer in the fibromuscular stroma is rare
* doesn’t contain glandular tissue
* surrounds the apex of the prostate

Question 12

Prostate Cancer

considerations when interpreting PSA levels

Answer 12

Long-term use of 5-alpha-reductase inhibitors
* Commonly used medications to treat benign prostatic hypertrophy
* Associated with ↓ PSA levels
* Correction factor should be applied for accurate interpretation

Urological conditions that can elevate PSA levels:
* Benign Prostatic Hypertrophy (BPH)
* Prostatitis
* UTI/Urinary retention
* Urological procedures (catheter placement, cystoscopy)

Repeat testing is recommended in the case of ↑ PSA (after addressing factors possibly influencing the elevation)

Question 13

Prostate Cancer

clinical variables to interpret PSA levels

Answer 13

AGE ADJUSTED
* 40-49 years of age: 2.5 ng/dL
* 50-59 years of age: 3.5 ng/dL
* 60-69 years of age: 4.5 ng/dL
* 70-79 years of age: 6.5 ng/dL

PSA VELOCITY
* more cancer = more rapidly rising PSA level
* 3 measurements over 2 yrs

Question 14

anatomy/phys of testis

Answer 14

• Responsible for production of sperm and androgens (testosterone)
• Ovoid structure measuring 3-5 cm
• One testis may be slightly larger and one testis (usually the left) with hang slightly lower

Tunica vaginalis
* Fascial layer that encapsulates the anterior 2/3 of the testis
* Location for potential fluid accumulation

Epididymis
* Tightly coiled, spongy, tubular structure located on the posterior aspect and running from a superior to inferior pole
* Aids in the storage and transport of sperm cells
* Facilitates sperm maturation

Spermatic cord
* Consists of the vas deferens and testicular blood vessels
* Transverses into the retropubic space

Question 15

causes of localized vs diffuse scrotal pain

Answer 15

Localized scrotal pain
* Testicular appendiceal torsion
* Acute epididymitis

Diffuse scrotal pain
* Testicular torsion
* Acute epididymo-orchitis or acute orchitis
* Fournier’s gangrene (necrotizing fasciitis of the perineum)