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75 Cards in this Set
- Front
- Back
Circumcision |
Typically done during infancy
Surgical removal of the foreskin of the penis
Recently, there has been a trend towards not circumcising - cultural thing |
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Potential Benefits of Circumcision |
- decreased risk of STD transmission |
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Potential Negative Effects of Circumcision |
- bleeding - infection - need for a repeat procedure (rare) - decreased sexual sensitivity |
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Structural Abnormalities of Penis |
Epispadias Hypospadias Phimosis Paraphimosis |
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Epispadias |
Opening on the dorsal shaft of the penis exposing the urethra
Does not need to be fixed unless it occurs very high up on the shaft |
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Hypospadias |
Abnormally placed urethral meatus
Lower on the penis |
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Phimosis |
Stenosis or narrowing of the preputial opening
Cannot pull the foreskin back off the head of the penis |
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Paraphimosis |
Strangulation of the glans penis which needs to be fixed immediately
Cannot pull the foreskin back over the head of the penis |
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Congenital Abnormailties of Male Reproductive System |
Kleinfelter's Syndrome - testicular atrophy and infertility
Cryptorchism - undescended testes - happens more commonly in premies - need to be surgically descended if they have not descended on their own by age 1 (risk of testicular cancer) |
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Infections of the Male Reproductive System |
Orchitis Epididymitis Prostatitis Urethritis Balantitis STD's |
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Orchitis |
Not very common in US
Typically seen w/ epididymitis
Caused by viruses or secondary syphilis (uncommon in US)
Decreased incidence after vaccine for mumps
Can cause infertility |
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Epididymitis |
Inflammation of the epididymis
Common in young males
Most common cause of swelling/ pain in the scrotum
Need to be able to differentiate from torsion! |
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Causes of Epididymitis |
- may or may not be related to infection * E. Coli, N. Gonorrhea
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Diagnosis if Epididymitis |
- cremasteric reflex intact - pain relived w/ elevation of the testes (phrens sign) |
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Treatment of Epididymitis |
- antibiotics - scrotal elevation - NSAID's - rest |
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Balantitis |
Inflammation of the glans penis
Localized or diffuse swelling, redness or ulceration
Viral or bacterial - herpes: ulcers = painful - syphilis: painless ulcers |
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Urethritis |
Inflammation of the urethra
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Types of Urethritis |
Bacterial (gonococcal) - purulent discharge - neisseria gonorrhea
Non-gonococcal - chlamydia trachomatis is the most common, but it can also be caused the ureaplasma urealyticum, haemophilus vaginalis and mycoplasma genitalium
Other - viral - parasitic - non-infectious |
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Signs & Symptoms of Urethritis |
- dysuria - penile discharge - urinary frequency |
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Prostatitis |
Typically occurs in older men
Types - acute or chronic - bacterial or non-bacterial
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Risk Factors of Prostatitis |
- manipulation of the urinary system - trauma - UTI |
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Signs & Symptoms of Prostatitis |
- pain - dysuria - urinary frequency - hesitancy - urgency - nocturia |
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Diagnosis of Prostatitis |
- rectal examination - urinalysis |
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Treatment of Prostatitis |
- antibiotics for 4 weeks (cipo or bactrim): increases risk of achilles tendon rupture - hospitalization in serious cases
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STD's |
Herpes Simplex Virus - Type II - painful ulcers - recurrent
Gonorrhea - purulent yellow discharge - dysuria
Chlamydia - often asymptomatic
HPV - genital warts in males - most common
Syphilis - primary: painless ulcers (chancre) - secondary: fever, chills, rash, condyloma latum - tertiary: latent phase; gummas, multiple symptoms; NO treatment |
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Scrotal Masses |
Vericocele Hydrocele Spermatocele
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Vericocele |
Mass of enlarged and ligated veins in the spermatic cord
Most common of the scrotal masses
Easily diagnosed
85% are left sided b/c blood drains at a 90 degree angle to the renal vein (not as good as the right side)
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Symptoms, Diagnosis and Treatment of Vericocele |
Symptoms - typically asymptomatic - may have an ache - can cause fertility issues
Diagnosis - exam - u/s
Treatment - support - surgery - embolization |
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Hydrocele |
Collection of fluid around the testicle
Typically painless
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Causes of Hydrocele |
- congenital - injury or trauma - radiation therapy |
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Diagnosis and Treatment of Hydrocele |
Diagnosis - transillumination - u/s to confirm
Treatment - none - surgery in extreme cases |
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Spermatocele |
Cyst develops in the epididymis
Blockage of sperm
Usually asymptomatic
May cause infertility |
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Testicular Torsion |
Torsion - acute onset of severe testicular pain
Twisting of the spermatic cord leading to the testicle causing a loss of blood supply - testicle can also slightly ascend
Common in adolescent men |
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Signs & Symptoms of Testicular Torsion |
- severe acute testicular pain - not much swelling |
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Risk Factors of Testicular Torsion |
Ball Clapper Deformity |
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Diagnosis of Testicular Torsion |
- clinical exam - confirm w/ u/s - absent cremasteric reflex |
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Treatment of Testicular Torsion |
- emergent surgery!! - if treated within 6 hrs 90% chance of saving testicle - if treated after 24 hrs 0% change of saving the testicle |
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Disorders of the Penis |
Peyronies Disease Priapism Fracture Erectile Dysfunction |
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Peyronies Disease |
Connective tissue disorder causing abnormal curvature - fibrosis pulls penis into curved shape
Can be mild or severe
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Treatment of Peyronies Disease |
Tricky to treat - medications - injections - surgery |
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Priapism |
Erection lasting longer than 4 hours
Happens more commonly in patients w/ sickle cell |
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Fracture |
Rupture of the tunica albuginea - muscles of the penis
Can be caused from trauma during sex - girl on top
Fix via surgical repair |
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Types Erectile Dysfunction |
Organic - most common - caused by a medical issue (hypertension)
Non-organic - psychological causes
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Treatment of Erectile Dysfunction |
- medications - injections - vacuum device (also used in post prostate surgery) - prosthesis |
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Prostate |
Walnut-sized gland located between the bladder and the penis
Lies in front of the rectum
Urethra runs through the center of the prostate - from the bladder to the penis
Secretes fluid that nourishes and protects sperm
During ejaculation, the prostate squeezes this fluid into the urethra, and it's expelled w/ sperm as semen |
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Prostate Diseases |
Benign Prostatic Hyperplasia (BPH) Infertility |
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Benign Prostatic Hyperplasia |
Enlargement of the prostate
Typically > age 50
Very common
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Pathology of Benign Prostatic Hyperplasia |
Changes in hormones w/ aging |
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Signs & Symptoms of Benign Prostatic Hyperplasia |
- urinary frequency - urgency hesitancy - decreased stream - dribbling - nocturia
In more extreme cases: - overflow incontinence - urinary retention - UTI's - hematuria |
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Diagnosis/Tests of BPH |
- symptoms of prostate significant antigen (PSA) - DRE - flow studies (measures amount and how fast they pee) - urodynamics - Cr - imaging studies |
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Treatment of BPH |
- meds (alpha blockers) - surgery: to clean out the prostate - catheterization |
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Infertility |
Unprotected intercourse for a 12 month period without a pregnancy - 15% of those in reproductive age
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Causes of Infertility |
- hypothalamic diseases - pituitary diseases - varicocele - epispadias - antisperm antibodies - obstruction - testicular failure - SCI - crypotorcism |
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Diagnosis of Infertility |
- H&P - hormone test - semen analysis |
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Male Reproductive Cancers |
Prostate cancer Testicular cancer Penile cancer |
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Prostate Cancer |
Most common cancer in males
3rd most common cause of cancer related deaths in men - people die w/ prostate cancer not from it
Genetic component
Related to testosterone
African Americans have a higher risk (screen at age 40)
Asians have a lower risk |
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Signs & Symptoms Prostate Cancer |
Often asymptomatic therefore routine screening is necessary
IF symptoms are present they are similar to BPH |
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Diagnosis of Prostate Cancer |
- elevated prostate specific antigen (PSA) * screened by prostate cancer cells - Digital rectal exam - U/S guided prostate biopsy |
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Prostate Cancer Pathology |
Originates in the peripheral zone (cannot feel on rectal exam)
Spreads adjacent organs via the lymphatics
Mets --> vertebral bones, lungs, liver
Gleason staging |
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Treatment of Prostate Cancer |
- active surveillance - radiation therapy - cryotherapy - hormone therapy (chemical castration) * testosterone feeds prostate cancer, but this takes away testosterone - surgery (prostatectomy; open, robotic) * robotic surgery has a slightly faster recovery time * make sure you don't cut the nerves (erectile dysfunction) - immunotherapy |
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Testicular Tumors |
1% of neoplasms in men
Most common neoplasm in men age 20-34
Treatable w/ early detection
Grows rapidly
Testicular lump - refer to urologist |
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Rule of 90's of Testicular Cancer |
- peak incidence in 25-45 yr old men (90%) - germ cell origin (90%) - most malignant (90%) - curable (90%)
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Risk Factors of Testicular Cancer |
- cryptorcisim - Kleinfelder's - estrogen - family history - HIV |
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Signs & Symptoms of Testicular Cancer |
- lump in testicle (may or may not have pain) - swelling - ache in lower abdomen - gynecomastia in 10% (increased breast tissue)
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Diagnosis of Testicular Cancer |
- scrotal u/s - tumor markers * helps to determine seminoma vs. non-seminoma |
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Treatment of Testicular Cancer |
Based on staging criteria - orchiectomy plus additional treatment (lymph node dissection, radiation, chemo)
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Types of Testicular Cancer |
Seminomas Nonseminomas |
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Seminomas |
- firm intramuscular mass - no typical serologic tumor markers - peak at age 40 - good prognosis
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Nonseminomas |
- testicular masses - younger men (30) - often have mets at diagnosis - hCGand AFP produced - requires more aggressive treatment: surgery, lymph node dissection, chemo |
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Other Testicular Tumors |
Lydig Cell Sertoli Cell |
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Lydig Cell Tumor |
- mostly benign - secrete hormone (testosterone or estrogen) - may cause precocious puberty, gynecomastia, decreased libido, feminization |
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Sertoli Cell Tumor |
typically benign testicular mass |
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Penile Cancer |
Rare in the US - seen in Asia, South America and Africa
Peak incidence in the 6th decade
Happens in - uncircumsized men - poor hygiene - smoking - diabetes
Environmentally induced?
Tumors typically in the Glans of the penis
98% is squamous cell cancer
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Signs & Symptoms of Penile Cancer |
- lesion without pain - thickened skin - palpable lymph nodes |
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Treatment of Penile Cancer |
- surgical removal of tumor |