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130 Cards in this Set

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List some general disorders of the male genitourinary system?
1. Disorders of erectile function

2. Benign prostatic hyperplasia; prostate cancer

3. Male infertility factors
List some disorders of the female genitourinary system?
1. Disorders of the cervix and uterus

2. Disorders of the fallopian tubes and ovaries

3. Menstrual disorders

4. Female infertility factors
Describe the tissue of the corpora cavernosa?
Contains spongy tissue surrounded by an elastic membrane.
Where are the corpus cavernosum and corpus spongiosum found?
Cavernosum = 2 on ventral side of penis.

Spongiosum = 1 on dorsal side of penis
An Erection is what kind of process?
Neurovascular process
An Erection is a neurovascular process requiring what 4 things?
1. Autonomic nervous system
2. Neurotransmitters
3. Endothelial relaxing factors
4. Vascular smooth muscle of arteries and veins supplying penile tissue
What part of the ANS predominates during an erection?
The parasympathetic predominates over the sympathetic (although both are involved). During erection it is relaxed. It is not in fight or flight mode. It involves acetylcholine.
What are some of the endothelial relaxing factors involved with erections?
NO, Prostaglandins
An Erection is controlled by the ?, but can be inhibited or stimulated by the ?. Explains.
Erection controlled by ANS, but can be inhibited or stimulated by CNS. The CNS is involved so erection does not depend solely upon physical stimulation.('the brain is involved, like visual stimulation for example')
Parasympathetic stimulation (NO release) causes what?
Parasympathetic stimulation (NO release) causes the smooth muscle of penile to:

1. Arterioles to relax

2. Veins to contract
What happens to the corpus cavernosa during an erection?
Corpora cavernosa lengthens and widens = erection
What is the ejaculation mediated by?
The SNS (so the sympathetic part of the ANS).
During ejaculation the SNS causes frequent strong contractions of what 6 structures?
1. Vas deferens

2. Epididymis

3. Seminal vesicles

4. Prostate

5. Urethra

6. Penis
Define erectile dysfunction?
The inability to achieve and maintain and erection sufficient to permit satisfactory sexual intercourse
How many men in the U.S. are affected by erectile and ejaculatory dysfunction?
Affects up to 30 million men in US. Over 50% of men after the age of 50 are afflicted.
List some causes of erectile dysfunction.
1. Psychogenic

2. Organic
a. Neurogenic
b. Hormonal
c. Vascular
What is the main downside of tx for erectile dysfunction?
Therapy can also compound the problem.
A psychogenic cause of erectile dysfunction involves what? Give examples.
Brain Function:

ex. 'brain function'

ex. performance anxiety

ex. depression

ex. schizophrenia
Give some examples of neurogenic causes of erectile dysfunction?
ex. Parkinsons (decreased dopamine)

ex. Stroke (decrease CNS)

ex. Trauma (decrease CNS)

ex. Spinal cord injury

ex. Somatosensory input decreases with age

ex. Prostate surgery
Give some examples of hormonal causes of erectile dysfunction?
ex. Decreased testosterone levels

ex. Increased prolactin (b/c of decreased FSH, LH in hypothalamus)

ex. Vascular issues (ex. artherosclerosis)

ex. Veins (insufficient in closing and blood does not stay in penis)
What is Benign prostatic hyperplasia (BPH)?
Age-related, non-malignant enlargement of prostate gland.
What is Benign prostatic hyperplasia characterized by?
Characterized by formation of large, discrete lesions around the urethra (periurethral regions)

(This is related to Prostate CA which affects the peripheral zones)
What is Benign prostatic hyperplasia caused by?
The cause is unknown.
List 6 risk factors associated with Benign prostatic hyperplasia?
1. Age

2. Family history

3. Race

4. Ethnicity

5. Dietary fat and meat consumption

6. Hormonal factors
HOw is age related to BPH?
Increased age = increased risk. 90% of men over 80yo have BPH.
What ethnicities are more at risk for BPH?
It is more common in african americans. Lowest in native japanese.
How are hormonal factors a risk factor for BPH?
If men have lowered testosterone (like a missing testicle or something) then they have a lower chance of having BPH.
What happens if someone with BPH has their testicles removed?
The prostate shrinks.
List 3 symptoms of BPH. Why do these symptoms occur?
1. Weak urinary stream, postvoid dribbling

2. Frequency of urination

3. Nocturia (going at night)

Symptoms occur because the urethra flows through the prostate. An enlarged prostate compresses the urethra and leads to symptoms.
List 3 ways that BPH may be diagnosed?
1. Digital rectal exam

2. Urine flow studies

3. Prostate-specific antigen (PSA) may be done to screen for CA
How is BPH tx generally?
from self-care to meds to surgery. Surgery usually only if it is going to progress to cancer.
Prostate cancer is the most common what?
The most common NON-SKIN cancer in the U.S.
Prosate Cancers is ? to lung CA as the cause of CA-related death in US men.
Second to lung cancer.
What ethnicity has the highest incidence of prostate cancer? Who has the lowest?
African American men have the highest. Asians and Native Americans have the lowest.
How is age related to the incidence of prostate cancer?
85% of prostate CAs are diagnosed in men greater than 65yo.
What is the cause of prostate cancer?
The cause is unknown. (but as with all cancers it is a multi-step process that may involve genes of growth and differentiation)
List 5 Risk factors for prostate cancer.
1. Age

2. Family history

3. Race

4. Dietary fat and meat consumption

5. Hormonal factors
Describe how family history is a risk factor for Prostate cancer?
This is esp. true if a primary relative (like a father or brother) has it. This gives an individual 8X more of a chance then someone with a second degree relative.
List 3 protective factors?
1. Dietary substances (lycopene, selenium, vitamin E)

2. Chemoprevention using 5a-reductase inhibitor like Finasteride

4. Reduced risk in men without BPH
Why would a 5 alpha-reductase inhibitor (finasteride) act as a protective factor against prostate cancer?
Because 5 alpha-reductase converts testosterone to a more potent dihydrotestosterone.
Describe the type of CA seen in prostate cancer.
Adenocarcinoma in 98% of primary prostatic CAs. Multicentric (so multiple lesions INSIDE the prostate), found in prostate periphery. Metastasis to lung and bone.
What sx are seen in the early stages of prostate CA?
The early stages of prostate cancer are often asymptomatic.
If Symptoms are seen what could it suggest about prostate CA? Give 4 examples.
Symptoms suggest locally advanced or metastatic disease.

1. Low back pain (fractures indicative of bone metastasis)

2. Weight loss

3. Anemia

4. Shortness of breath

(by this point it is advanced and difficult to tx)

(there may also be changes in voiding patterns, depending on size and location)
Describe some methods of Diagnosis and Screening for prostate cancer
1. PSA test: prostate-specific antigen, used for screening; change in PSA level over time, if there is a large increase then there is possible CA

2. Confirmation via biopsy
Define Infertility.
Inability to conceive a child after one year of unprotected intercourse
What is the prevalence of infertility in the U.S.?
~15% of couples in the U.S.
What is primary infertility?
Infertility with no prior conception.
What is secondary infertility?
Infertility after one or more previous pregnancies that were carried to term. This is not necessarily the woman's issue. The problem could be from the male or female.
What percentage of infertility is attributed to males?
~ 25 – 35% of inferitility
The diagnosis of infertility in men requires what 3 things?
1. history

2. physical

3. lab test
What percentage of infertility is attributed to females?
~50% of infertility.
What does the diagnosis of infertility in women require?
1. Menstrual history

2. Lab tests

3. Pelvic exam
What percentage of infertility is unexplained?
~15-25% of infertility.
List 5 male infertility factors?
1. Sperm Disorders

2. Immunologic Disorders

3. Hormones

4. Genetics

5. Structural and Congenital Abnormalities
List 2 sperm disorders?
1. Azoospermia

2. Oligospermia
What is azoospermia?
Virtually no sperm in ejaculation.
What is oligospermia?
Abnormally low number of sperm.
Are azoospermia and oligospermia the only sperm disorders?
No, there are many more than just these. They pretty much all involve problems with differentiation.
Describe how immunologic disorders are related to male infertility?
Antibodies to own sperm. Due to surgery, infection, trauma, compromised blood testes barrier, etc.
List 4 general Structural and congenital abnormalities resulting in infertility?
1. Obstruction: numerous
ex. Prostate enlargement
ex. Testicular torsion

2. Congenital: hypospadias and cryptorchidism

3. Varicocele

4. Surgeries: e.g., vasectomy
What is the most common acute testicular disorder?
Testicular torsion (twisting)
What occurs during testicular torsion?
The vas deferens is twisted/obstructed. The testicles can die due to tissue necrosis. If this endures it requires surgery.
Describe cryptorchidism?
Means 'undescended testicles'.


This is seen in premature infants (22% of them). This usually represents failure of the testis to move, or "descend," during fetal development from an abdominal position, through the inguinal canal, into the ipsilateral scrotum. About 3% of full-term and 30% of premature infant boys are born with at least one undescended testis, making cryptorchidism the most common birth defect of male genitalia. (testes may stay in abdominal cavity)
What occurs with most cases of cryptorchidism?
In 75% of cases the undescended testicles will descend on own within 3 months. If it persists for more than 3 months surgery or hormonal therapy may be reqd.
Why would cryptorchidism have to be tx?
It needs to be tx because it can increase the risk of cancer and increases the risk of testicular torsion.
Would cryptorchidism left untreated effect sperm production?
If left uncorrected the environment would not be ideal for sperm. However, the other testicle would produce more than enough sperm. (so mainly tx to avoid increased risk of cancer)
What are hypospadias?
Hypospadias is a birth defect of the urethra in the male that involves an abnormally placed urethral meatus (opening). This can be repaired. Surgery is typical within 6-12 months of infancy.
What is varicocele?
Abnormally large veins in the scrotal sac.
When is there an increased incidence of varicocele?
See a higher incidence in men between 15 - 35yo.
How is varicocle tx?
Usually surgery.
What is the most common reason for infertility in men?
Varicocele
How prevalent is cervical CA in the US?
12,200 cases of INVASIVE cervical CA in US.

4100 deaths. So about 1/3rd die.
How prevalent is cervical CA worldwide?
About 1/2m cases each year. It is the 3rd most common cancer.
Is cervical carcinoma in situ treatable?
It is easily detected and cured. Detected by PAP smears.
Cervical CA is considered what? Why?
It is considered an STD because it is Viral.
There is a causal link between cervical CA and ?.
Between cervical CA and HPV infection.
List some risk factors for cervical cancer.
1. Early age at first intercourse

2. Multiple partners

3. Promiscous male partner

4. Smoking

5. STD history
In cervical CA the cancer itself arises from what? This begins with the development of what?
Cancer arises from precursor lesions, beginning with the development of atypical cells.
Once cervical CA arises from precursor lesions what does it gradually progress to?
Gradually progresses to carcinoma in situ (localized to epithelial layer) and to invasive CA of the cervix (deeper). (This doesn't necessarily always occur)
Pap smears are conducted to observe what?
1. Changes in cells' nucleus and cytoplasm

2. Variation in cell size and shape (dysplasia) detected via histology
What is cervical intraepithelial neoplasia (CIN)?
AKA cervical dysplasia. Abnormal growth detected by grading system which describes changes in cancer precursors.
Noninvasive cancer is limited to what tissue?
Limited to epithelial tissue layer. This is 'carcinoma in situ'.
What is endometriosis?
A cond. in which functional endometrial tissue is found in ectopic sites outside of the uterus. (sites like the ovaries, posterior broad ligaments, pelvis, and vagina)
What is the cause of endometriosis?
Unknown
List some theories for possible causes of endometriosis.
1. Retrograde menstruation where dormant immature cellular elements undergo metaplasia in distant sites

2. Metastasis via lymphatics or vasculature
Where is an increasing incidence of endometriosis observed?
Increasing incidence in W. societies over the past 40-50 years. It is unknown why but may be more common in women who have postponed childbearing.
List risk factors for endometriosis.
1. Early menarche (young onset of menstration)

2. Regular periods with shorter cycles (<27days), longer duration (>7days), heavier flow

3. Increased menstrual pain

4. First-degree relatives
List some sx associated with endometriosis?
Sx are varied, but strongly suggested by:

1. Dysmenorrhea

2. Dyspareunia

3. Infertility
How is endometriosis diagnosed?
Laproscopy (visualize cells)
List 5 common sites for endometriosis.
1. Ovary

2. Rectum

3. Uterus

4. Bladder

5. Normal endometrium lining
What are leiomymomas AKA?
Fibroids or uterine fibroids
What is a leiomymoma?
Benign neoplasms of smooth muscle origin. It is the most common cause of pelvic tumor.
What is the believed prevalence of leiomymomas?
Believed to occur in 1 of every 4 to 5 women over the age of 35 years.
Describe the sx associated with leiomymomas.
1. >50% asymptomatic

2. Discovered on routine pelvic exam (Dr. feels for tumors)

3. Menorrhagia (xs menstrual bleeding)

4. Anemia

5. Urinary frequency

6. Rectal pressure/constipation
With leiomymomas what occurs once a woman reaches menopause?
Once a women reaches menopause, hormonal stimulation decreases and most fibroids regress. If not a historectomy may be warranted. (if a woman has not had menopause and wants kids then they can just remove fibroids...not a historectomy)
Are leiomymomas dangerous?
No real danger in and of themselves but they may cause secondary problems.
What does pelvic inflammatory disease (PID) involve?
Inflammation of the upper reproductive tract and may involve:

1. Uterus (endometritis)

2. Fallopian (salpingitis)

3. Ovaries (oophoritis)
What is pelvic inflammatory disease generally caused by?
Infection
List 5 risk factors for PID.
1. Age: 16-24

2. Unmarried

3. Nulliparity

4. Multiple sexual partners

5. Previous history of PID
List 5 sx of PID.
1. Lower abdominal pain

2. Purulent cervical discharge (pus)

3. Adnexal tenderness (accessory organs)

4. Very painful cervix

5. may/may not have sx of infection (like fever, increased wbc count)
How is PID tx?
Antibiotics
PID may lead to ? tissue.
PID may lead to scar tissue which may lead to adhesions of different structures in the reproductive tract. This can cause obstructions that lead to infertility.
List 3 menstrual disorders.
1. Amenorrhea

2. Dysmenorrhea

3. Premenstrual Syndrome (PMS)
Dysfunctional menstrual cycles are related to what?
Related to alterations in HORMONES that support normal cyclical endometrial changes.
What is amenorrhea?
Lack of menstration. May be primary of secondary.
What is primary amenorrhea?
Failure to menstruate by 16yo. Or the failure to develop secondary sexual characteristics by the age of 14yo. (ex. poor gonad development, defective development of mallarian tubes...something wrong with hormonal axis/hypo-pit axis)
What is secondary amenorrhea?
Observed in women who have had menstruation but it ceases for 6mo. or more. This (like primary) involves hormonal changes. (this can be seen in anorexics and athletes who often fail to menstruate, some have such a lack of body fat that they couldn't support a pregnancy anyway)
Whay is dysmenorrhea?
Pain and discomfort during mentstration.

Could be secondary (due to physical problems like fibroids, etc).

Could be primary where there is no physical cause but pain is felt 1-2d b/f menstruation and then peaks the first day of menstruation.
How would you tx primary dysmenorrhea?
Just tx the sx.
How would you tx secondary dysmenorrhea?
Tx the cause.
What is hypomenorrhea?
Little menstruation
What is oligomenorrhea?
'few'
What is Polymenorrhea?
Menstruation that occurs too often.
What is menorrhagia?
Excessive bleeding
Describe PMS?
Premenstrual Syndrome (PMS). This is related to hormones. For 20-40% of women there are more severe sx than normally observed.
How might severe pms be tx?
With oral contraceptives.
List 6 possible female infertility factors.
1. Anatomic abnormality

2. Genetic abnormality

3. Hypothalamic dysfunction

4. Pituitary dysfunction

5. Ovarian failure

6. Other causes
List 4 possible anatomic abnormalities associated with female infertility factors.
1. Vaginal and uterine aplasia

2. Cervical stenosis

3. Asherman's syndrome

4. Tumors (inc. fibroids)
What is cervical stenosis?
The closing of the cervix. (this is an anatomic abnormality that may be a female infertility factor)
What is Asherman's syndrome?
Intra-uterus adhesions
Why do pituitary dysfunctions cause female infertility?
Interferes with LH and FSH secretions.
List 5 aspects of the medical mgmt of infertility.
1. Workup of both partners (medical, surgical, drug history)

2. Rule out structural abnormality (varicocele, obstruction, etc)

3. Manage underlying disease (diabetes, hypopituitarism, orchitis, etc)

4. Tx infection

5. Use alternative reproductive technology
List 8 types of assisted reproductive technology?
1. Ovulatory-inducing drugs (hormones)

*2. In-vitro fertilization

3. Blastocyst transfer

*4. Intracytoplasmic sperm injection

5. Oocyte donation

6. Cytoplasmic transfer

7. Use of surrogate parent

*8. Cloning

(* = what she focused on in class)
In-vitro fertilization was first used successfully in what year?
1978
Describe in-vitro fertilization. (7)
1. Ovaries are basically super stimulated using FSH

2. Produce multiple follicles

3. Follicular dev. is monitored (ultrasounds, estrogen concentration in blood etc)

4. LH surge is induced (done with analog of LH = HCG = Human Chorionic Gonadotropin hormone)

5. Aspirate follicles, find ova

6. Inseminate ova IN VITRO (outside woman's body)

7. If fertilized, eggs returned back to woman's uteruse
What is the success rate of in vitro fertilization?
20-50% depending on the clinic. So may take a couple rounds of tx.
Describe intracytoplasmic sperm injection.
This may be used at times such as when a man has oligospermia. Must harvest eggs and sperm and basically inject sperm into an egg cell/ovum.
Describe the process of cloning.
1. Female, gamete + Female or male, somatic cell needed

2. The nucleus is removed from both cells and inserted into ovum.

3. This gives a clonal zygote

4. The ultimate result is a clonal embryo that is not identical to either of the original cells
List 5 animals that have been successfully cloned.
1. Pigs

2. Cows

3. Mice

4. Cats

5. Rabbits
What is telomere length associated with?
Tumors, infection, and lifespan. Shorter telomeres related to shorter lifespan.