Unit 4: Chapter 43

Question 1

Hypospadias

Answer 1

Congenital disorders resulting from embryo logic defects in the development of hte urethal groove and penile urethra.
1 in 350 male infants.
The urethral opening or meatus may be along the underside of the shaft of the penis, the scrotum, or the perineum.

Question 2

Epispadias

Answer 2

which the opening of the urethra is on the dorsal or upper surface of the penis, is less common than hypospadias.
May occur as a separate entity, it is often associated with exstrophy of the bladder, where the bladder protrudes through a weakness in the abdominal wall.
Treatment depends on the extent of the developmental defect.

Question 3

Paraphimosis

Answer 3

the foreskin is so constricted that it cannot cover the glans.
A tight foreskin can constrict blood supply and lead to ischemia and necrosis. Many cases are due to the foreskin being retracted for an extended period, as in the case of catheterized uncircumcised males.
Can present as a swollen, tender penis with multiple skin folds under the glans.

Question 4

Peyronie Disease

Answer 4

localized and progressive fibrosis of unknown origin that affects the tunica albuginea of the penis.
Most commonly after 40 years of age.
It is characterized initially by inflammation resulting in dense fibrous plaque formation.
The plaque is usually on the dorsal midline of the shaft, causing upward bowing of the shaft during erection

Question 5

Peyronie Disease Manifestations

Answer 5

include painful erection, bent erection, and a hard mass at the site of fibrosis.
During the first year after formation of the plaque, while the scar tissue is undergoing remodeling, penile distortion may increase, remain static, or resolve and disappear.
In some cases, the scar tissue may progress to calcification and formation of bonelike tissue.

Question 6

Erection

Answer 6

is a neurovascular process involving the autonomic nervous system, neurotransmitters and endothelial relaxing factors, vascular smooth muscle of the arteries and veins supplying the penile tissue, and trabecular smooth muscle of the sinusoids of the corpora cavernosa

Question 7

Erectile Dysfunction

Answer 7

is the persistent inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse.
Has a physical etiology for most men, commonly involving blood flow to and from the penis.

Question 8

ED Causes

Answer 8

include performance anxiety, a strained relationship with a sexual partner, depression, and overt psychotic disorders.
Psychogenic factors can be exacerbated by the side effects of many therapies used to treat these disorders, which can themselves cause ED.
Common in people with diabetes

Question 9

ED Diagnosis and Treatment

Answer 9

Requires careful history, exam, labs to rule out organic causes
Many meds can cause ED.

Should consider the partner’s attitude about the problem and the likely response to effective treatment.
Methods include psychosexual counseling, androgen replacement therapy, oral and intracavernous drug therapy, vacuum constriction devices, and surgical treatment.

Question 10

Cryptorchildism

Answer 10

(undescended testes) (most common in male infants)
Occurs when one or both testicles fail to move down into the scrotal sac. Undescended testes may remain in the lower abdomen, at a point of descent in the inguinal canal, or in the upper scrotum

Question 11

Hydrocele

Answer 11

collection of fluid in the scrotum without an obvious inguinal hernia.

Question 12

Hematocele

Answer 12

an accumulation of blood in the space between the parietal and visceral tunica vaginalis, which causes the scrotal skin to become dark red or purple.
Hematocele is often associated with hydrocele. It may develop as a result of an abdominal surgical procedure, scrotal trauma, a bleeding disorder, or a testicular tumor.

Question 13

Spermatocele

Answer 13

is a painless, sperm-containing cyst that forms at the end of the epididymis. It is located above and posterior to the testis, is attached to the epididymis, and is separate from the testes.

Question 14

Varicocele

Answer 14

is varicosities of the pampiniform plexus, a network of veins supplying the testes.
The left side is more commonly affected.
Rarely found before puberty.

Question 15

Intravaginal Torsion

Answer 15

e tunica vaginalis is attached securely to the posterior lateral side of the testicle.
If attachment to the testicle is too high, the spermatic cord can rotate, resulting in intravaginal torsion.
Common in adolescents.

Question 16

Epididymitis

Answer 16

is an acute or chronic inflammation of the epididymis.

presents as gradual onset of posterior testicular pain, usually unilateral.
Pain may radiate to the lower abdomen.
Acute epididymitis usually involves pain, swelling, and inflammation of the epididymis that lasts less than 6 weeks.
Chronic epididymitis has the same symptoms for 6 weeks or more.

Question 17

Epididymitis Causes

Answer 17

aused by multiple infectious, noninfectious, and even postinfectious microbial sources.
In most cases of bacterial epididymitis, retrograde ascent of the organisms is the mechanism of infection.
In other cases, such as Mycobacterium tuberculosis, hematogenous spread or seeding of the epididymis is the mechanism of infection

Question 18

Epididymitis Treatment

Answer 18

focuses on treating the cause of the infection while reducing adverse symptoms.
Empiric antibiotic therapy is indicated before laboratory test results are available.
The goals of treatment of acute epididymitis caused by C. trachomatis or N. gonorrhoeae include curing the infection, limiting signs and symptoms, preventing transmission, and decreasing the potential for complications such as infertility or chronic pain.

Question 19

Testicular Cancer

Answer 19

Unknown cause.

Risk factors include cryptorchidism, genetic factors, and disorders of testicular development.
Family clustering of the disorder has been described. There is an increased incidence of testicular germ cell tumors, particularly seminomas, in HIV-positive males.

Question 20

Testicular Cancer Manifestations

Answer 20

First sign of testicular cancer is slight enlargement of the testicle, potentially with some discomfort (ache in the abdomen or groin or a sensation of dragging or heaviness in the scrotum).
It can spread when the tumor is barely palpable.
Signs of metastatic spread include swelling of the lower extremities, back pain, neck mass, cough, hemoptysis, or dizziness.

Question 21

Seminomas

Answer 21

account for approximately 40% of germ cell tumors and are most frequent in the fourth decade of life.
thought to arise from the seminiferous epithelium of the testes and are the type of germ cell tumor most likely to produce a uniform population of cells.

Question 22

Prostate

Answer 22

A firm, glandular structure that surrounds the urethra. It produces a thin, milky, alkaline secretion that aids sperm motility by helping to maintain an optimum pH.
The contraction of the smooth muscle in the gland promotes semen expulsion during ejaculation.

Question 23

Prostatitis

Answer 23

is a variety of inflammatory disorders of the prostate gland.
It may be spontaneous, as a result of catheterization or instrumentation, or secondary to other diseases of the genitourinary system.

Question 24

Acute Bacterial Prostatitis

Answer 24

is an acute infection of the prostate gland that results in pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention, and may lead to systemic symptoms, such as fevers, chills, nausea, emesis, and malaise.
Most are caused by ascending urethral infection or intraprostatic reflux

Question 25

Chronic Bacterial Prostatitis

Answer 25

is a subtle disorder that is difficult to treat. It is most often caused by E. coli or other gram-negative typically affects males 36 to 50 years of age. After an episode of acute bacterial prostatitis, 5% of patients may progress to chronic bacterial prostatitis.

Question 26

Acute Bacterial Prostatitis Exam Findings

Answer 26

Physical examination includes an abdominal examination to detect a distended bladder and costovertebral angle tenderness, a genital examination, and a digital rectal examination. Rectal examination reveals a swollen, tender, warm prostate with scattered soft areas. Prostatic massage produces a thick discharge with white blood cells that grows large numbers of pathogens on culture.

Question 27

BPH Causes

Answer 27

With age, the amount of active testosterone in their blood decreases, resulting in a higher proportion of estrogen. BPH may be a result of this higher proportion of estrogen-promoting prostate growth.

Question 28

BPH Treatment

Answer 28

may include lifestyle changes, medications, minimally invasive procedures, and surgery. Medication: 5a-Reductase inhibitor reduce the prostate sign by blocking the effect of androgens on the prostate.

Question 29

Prostate Cancer

Answer 29

Most common non skin cancer Disease of aging Development appears to be a multistep process involving genes that control cell differentiation and growth.

Question 30

Prostate Cancer Screening

Answer 30

Asymptomatic so screening is a must currently available are digital rectal examination, PSA testing, and transrectal ultrasonography. A positive PSA test indicates a possible presence of prostate cancer, BPH, or prostatitis.

Question 31

Prostate Cancer Screening

Answer 31

is commonly classified using the Gleason grading system. Primary stage tumors (T1) are asymptomatic and discovered on histologic examination T2 tumors are palpable on digital examination but are confined to the prostate gland T3 tumors extend beyond the prostate T4 tumors have pushed beyond the prostate to involve adjacent structures.

Question 32

Prostate Cancer Treatment

Answer 32

treated by surgery, radiation therapy, and hormonal manipulations. Chemotherapy has limited effectiveness. High-intensity focused ultrasound may be successful. Expectant therapy (watchful waiting) may be used if the tumor is not producing symptoms, is expected to grow slowly, and is small and contained. This approach is particularly suited for males who are elderly or have other health problems.