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33 Cards in this Set

  • Front
  • Back
Hyposadias
Opening of urethra on inferior surface of penis



Due to failure of urethral folds

Epispadias
Opening of urethra on superior surface of penis



Due to abnormal positioning of the genital tubercle




Assoc with bladder extrophy

Condyloma Accuminatum
HPV 6 or 11 = koilocytic change



Branching papillary, villous connective tissue stroma




Epithelium with hyperkeratosis, acanthosis and koilocytosis




No high grade dysplasia

Phimosis
Orifice of prepuce too small to permit normal retraction

Anomalous




More commonly due to repeated infection Increased risk of infection and carcinoma

Balanoposthitis


Infection of glans and prepuce

Candida, anaerobes and Gardnerella




Leads to smegma (Accumulation of desquamated epithelial cells, sweat and debris)

Peyronie disease
Fibrous bands of corpus cavernosum (benign tumor)



Penile curvature and pain during intercourse

Bowen disease
Type of carcinoma in situ (HPV16) of penile shaft or scrotum



>35




Presents as leukoplakia (solitary, thickened, gray-white plaque)

Bowenoid papulosis
Type of carcinoma in situ (HPV16)



Occurs in sexually active adults, generally younger than Bowen Disease


multiple red-brown papular lesions




Does not progress to invasive carcinoma Regression with no therapy, just destruction of lesions

Invasive Carcinoma
Poor hygiene + high risk HPV (16)



Papillary or flat lesions on glans or inner surface of prepuce near coronal sulcus




Slowly growing and locally invasive


Metastases to inguinal lymph nodes




Negative lymph nodes – 66% 5 year survival


Positivelymph nodes – 27% 5 year survival

Cryptoorchidism
Failure of testicle to descend into scrotal sack



Most common congenital male repro abnormality




Orchiopexy if it's not resolved by age of 2.


Tack the testicle down to the scrotal sack because the high temperature of the testicle in the body leads to atrophy and infertility and seminoma




Marked hyalinization and basement membrane thickening


Leydig cells appear prominent


May see same changes in other descended testis

Orchitis pathophysiology and causes
Inflammation of the testicle



Causes


1) Chlamydia trachomatis (serotypes D-K) or Neisseria gonorrhea, young aduls. Risk of sterility, but libido is fine because Leydig are fine.




2) E. coli and Pseudomona = UTI, older adults




3) Mumps virus, increased infertility, usually not seen in <10yo




4) Autoimmune orchitis = granulomas in seminiferous tubules




Congestion, edema and neutrophils


Can progress to abscess




Begins in epididymis then spreads to testis


Can lead to scarring and sterility

Testicular torsion
Twisting of the spermatic cord cuts off venous drainage, leading to congestion and hemorrhagic infarction



Usually due to congenital failure of tests to attach to inner lining of the scrotum.




Manual untwisting within 6 hours may preserve viability




Neonatal = shortly after birth


Adult = adolescent males




Sudden pain, lack of cremasteric reflex

Varicocele
Dilation of spermatic vein due to impaired drainage



Scrotal swelling with bag of worms appearance




Left sided vein drains into left renal vein, while right goes directly to IVC, so it's usually left-sided.




ASSOCIATED WITH LEFT SIDED RENAL CELL CARCINOMA.




Seen in a large percentage of infertile males

Hydrocele
Fluid collection within the tunica vaginalis (serous membrane that covers testicle and internal scrotum)



Associated with incomplete closure of the vaginalis.


Leads to peritoneal communication in infants or lymph obstruction in adults.




Scrotal swelling that can be illuminated

Seminoma
Malignant Germ cell tumor



50% of testicular tumors




Large cells with clear cytoplasm and central nuclei, forming a homogenous mass with no hemorrhage or necrosis




Sheets of polygonal cells with prominent nucleoli and a lymphoid infiltrate




Resembles ovarian dysgerminoma




Rare cases produce β-hCG




Good prognosis, responds to radiotherapy

Embryonal carcinoma
Malignant germ cell tumor



Immature, primitive cells that may produce glands.




Hemorrhagic + necrosis (unlike seminoma)




Varigatedwith foci of hemorrhage and necrosis Cells in alveolar, tubular, or papillary patterns or as sheets


Large anaplastic epithelioid appearing cells with prominent nucleoli, tumor pleomorphism, tumor giant cells and mitoses




Aggressive, early hematogenous spread


Chemo may cause it to morph into teratoma


Increased HFP or b-HCG

Endodermal sinus tumor (yolk sac tumor)
Malignant germ cell tumor

Resembles yolk sac elements


Most common testicular tumor in children




SCHILLER-DUVAL BODIES (glomerulus-like structures)




Cells arranged in a lace-like pattern with cells surrounding vessels and containing hyaline globules




AFP ELEVATED

Choriocarcinoma
Malignant germ-cell tumor



Multinucleated cells with large amounts of hemorrhage and necrosis




Placenta-like tissue without villi




Spreads early via blood (like embryonal carcinoma)




b-HCG elevated and may lead to hyperthyroidism or gynecomastia due to similar structure to FSH, LH, TSH

Teratoma
Germ cell tumor composed of mature tissue derived from two or three embryonic layers



MALIGNANT IN MALES (as opposed to females)

Behavior of seminoma vs non-seminoma germ cell tumors
Seminomas

remain localized longer


70% present at Stage I


Lymph spread


Radiosensitive


Non-Seminoma Germ Cell Tumor


Hematogenous spread early


60-70% present at Stage II/III


Overall more aggressive, worse prognosis


90% remission if you use aggressive chemo

Lymphoma
Most common cause of testicular mass in males >60, often bilateral



Usually of diffuse large B-cell type

Prostatitis, causes, presentation, etc
Acute inflammation of prostate.



Usually due to Chlamydia/Gonorrhea in young adults.


E.coli and pseudomonas in older adults.




Dysuria + fever and chills (low back pain = chronic)




Tender, boggy prostate on DRE


Prostatic secretions show WBC's, positive urine culture

BPH, pathophysiology, relation to DHT, presentation
Hyperplasia of prostatic stroma and glands

Age-related change (usually after 60 years)




DHT acts on the androgen receptor of stromal and epithelial cells leading to hyperstatic nodules




central periurethral zone of prostate




Starting/stopping issues


Impaired emptying leading to infection


Dribbling


Hypertrophy of bladder, increased risk of diverticula




PSA elevated

BPH treatment
1) alpha1 antagonist (terazosin) relax smooth muscle. Also lowers BP. Selective alpha 1A antagonists (tamulosin) are used in normotensive



2) 5alpha-reductase inhibitor


Blocks conversion to DHT. Takes months to produce results. ALSO used in male pattern baldness.

Prostate adenocarcinoma
Most common cancer in men. 2nd most common cancer-deaths.



AA > Caucasian > Asian/


Usually arises in peripheral posterior region of prostate, so doesn't initially produce urinary symptoms.




Screen beginning at 50 yo.


Normal serum PSA increases with age due to BPH


PSA > 10 is highly worrisome no matter age




Decrease in % free-PSA (cancer is bound PSA) Increased alkaline phosphatase




Small, invasive glands with prominent nucleoli




Spreads to lumbar spine or pelvis commonly. Low back pain

Gleason grading stystem
Multiple regions of tumor assessed

Score 1-5 is assigned for 2 areas then added together.




2-4 indolent


5-7 treatable


8-10 lethal


Higher score = worse prognosis

Prostate adenocarcinoma treatment
Prostatectomy if localized. Hormone suppression if it's advanced.



1) Continuous GnRH analogues (leuprolide) to shut down LH and FSH from anterior pituitary


2) Flutamide (androgen receptor competitive inhibitor)

Epidydymitis
Holding urine for a long time in history (±)



Physical activity causing leakage or pain




Prepubertal = E.coli or congenital


<35 = Gonorrhea, Chlamydia


>35 = E.coli, pseudomonas

Treatment for erectile dysfunction
Phosphodiesterase-5-inhibitors (sildenafil, vardenafil, taladafil)

Vacuum constriction/devices


Anti-depressants (SSRI's)

Indirect inguinal hernia pathophysiology
Hernia passes through internal inguinal ring lateral to inferior epigastric artery, into canal with testicular A/V and vas deferens



MC in young men and women<5% strangulate

Direct inguinal hernia pathophysiology
Hernia passes through abdominal wall medial to inferior epigastric artery in Hesselbach triangle



Elderly men


Only 30% of inguinal hernias

Femoral hernia pathophysiology
Hernia in upper medial thigh below inguinal ligament



FEMALE PREDOMINANCE




High chance of strangulation

Treatment for Peyronie Disease
Vitamin E (?)TamoxifenVerapamilInf a-2bColchicineAminobenzoate