Problems Of The Male Reproductive System

Front 1

Describe the normal anatomy of the prostate.

Back 1

Approximately 3cm long, 4
cm wide and 2 cm in AP depth

Front 2

What are the 3 zones of the prostate?

Back 2

3 glandular regions
– Peripheral zone (PZ)
• 70%
• Surrounds urethra
– Central zone (CZ)
• 25%
• Surrounds ejaculatory ducts
– Transition zone (TZ)
• 5%
• Surrounds proximal urethra
• Secretes a fluid making up semen

Front 3

What is the aetiology of BPH?

Back 3

– Advancing age
– Testicular androgens
• Age related enlargement results from increased cellular proliferation and decreased apoptosis
– Other contributing factors
• Oestrogens
• Prostatic stromal and epithelial tissue interactions
• Neurotransmitters from the gland

Front 4

What are the symptoms of BPH?

Back 4

– Weak or interrupted flow of urine
– Frequent urination (nocturia)
– Trouble urinating
– Pain or burning during urination
– Blood in urine or semen
• SHITE = Slow stream, Hesitancy, Intermittent flow, Terminal dribbling, Emptying is incomplete.
• FUN = Frequency, Urgency, Nocturia

Front 5

What is the epidemiology of BPH?

Back 5

All men over the age of 40:
– 50% will develophistological hyperplasia
– 50% of these with have lower urinary tract
symptoms (LUTS)
– Some will develop significant enlarged
prostate (EP)
– Some will develop bladder outlet obstruction (BOO)

Front 6

What is the diagnosis of BPH?

Back 6

• History
• Digital rectal exam (DRE)
• Ultrasound
– biopsy
• Blood test
– Prostate specific antigen
(PSA, gammaseminoprotein or kallikrein-3)
– 40 - 49 yrs 0 - 2.5 ng/ml
– 50 -59 yrs 0 – 3 ng/ml
– 60 - 69 yrs 0 – 4 ng/ml
– > 70 yrs 0 – 5 ng/ml
– Less than 10ng/ml is usually due to BHP

Front 7

What is standard treatment for BPH?

Back 7

• Pharmacotherapy
– α1-adrenergic blockers
• Relaxes smooth muscle in bladder neck and
prostate improving urine flow rate
– 5-α-reductase inhibitors
• 2 isoforms type I and type II (type II
predominant prostatic reductase)
• Dustasteride both I & II
• Finasteride only type II
– combinations

Front 8

What surgery is possible for BPH?

Back 8

Transurethral resection of the prostate:

– Failed voiding trials
– Recurrent gross hematuria
– Urinary tract infection
– Renal insufficiency secondary to obstruction

Open prostatectomy:

– For very large prostates
• >75g
• Concomitant bladder stones
– Inner core “shelled out” leaving peripheral zone

ALSO:
• Laser ablation
• Transurethral microwave
• High energy ultrasound therapy

Front 9

What are the differences between direct and indirect inguinal hernias?

Back 9

Front 10

What are the types of hernias?

Back 10

Front 11

What is the anatomy of the inguinal rings?

Back 11

Front 12

What is the epidemiology of inguinal hernias?

Back 12

Approx 25% of males will have inguinal hernias in
their lifetime
– 2% of females
– Direct or indirect

Front 13

What is the anatomy of direct inguinal herniass?

Back 13

Front 14

What is the treatment for direct inguinal hernias?

Back 14

Treatment
– Reducible = truss
– Surgery

Front 15

What is an indirect inguinal hernia?

Back 15

Front 16

Describe this laparoscopic view of a right direct inguinal hernia.

Back 16

Front 17

Give a summary of the characteristics of direct and indirect hernias.

Back 17

Front 18

What is erectile dysfunction and when is it seen?

Back 18

Front 19

Describe the anatomy of the penis.

Back 19

Front 20

Describe the penile vascular anatomy when erect.

Back 20

Front 21

What happens to the lacunar space during erection?

Back 21

Front 22

What 4 things can centrally control erection?

Back 22

Front 23

What is the effect of sympathetic and parasympathetic activation of smooth muscle nerve terminals of the penis?

Back 23

Front 24

What is the role of NO in ED?

Back 24

Front 25

What is the treatment of ED?

Back 25

+ penile prosthesis.