Male Reproductive Case Studies, 9, 10, 11, 12

Front 1

a male aged 30 years old, presents with aslight enlargement in his left scrotum

Namefour possible differential diagnoses.

Back 1

Hydrocele

Haematocele

Varicocele

Testicularcancer

Front 2

Define Hydrocele

Back 2

Accumulation of serous fluid in a body sac

Front 3

Define Haematocele

Back 3

Accumulation of bloodin the tunica vaginalis

Front 4

Define Varicocele

Back 4

A mass of Varicose veins in the spermaticcord

Front 5

Define Testicular cancer

Back 5

A cancer that develops in the testicles,Not all lumps on the testicles are tumours and not all tumours are malignant

Front 6

Describe the structure of the scrotum

Back 6

* Pouch or sac

Front 7

a male aged 30 years old, presents with aslight enlargement in his left scrotum

From his history, it is determined theswelling is also accompanied with a dragging sensation,some degree ofdiscomfort and a dull ache in the abdomen and groin. What is the most likediagnosis?

Back 7

Testicular cancer

Front 8

Describethe structure of the testis.

Back 8

§ Tunica vaginalis – fromvaginal process out pouching of the peritoneal cavity

– Superficial parietal layer

– Cavity – serous fluid

– Visceral layer (sinus epididymus)

§ Tunica albuginea – fibrouscapsule of testis

§ Septum divides testis into250-300 lobules

§ Each lobule contains 3-4seminiferous tubules

§ Seminiferous tubules → tubulusrectus → Rete testis in Mediastinum testis (a region of dense connective tissuein the posterior part of the testis) → efferent ductules

Front 9

What are the clinical manifestations oftesticular cancer

Back 9

· Enlargementof the testicle

· Some degreeof discomfort

· Dull achein abdomen or groin area

· Draggingsensation or heaviness in scrotum

· Frank painin later stages with enlargement and haemorrhage of testicle

Front 10

a male aged 30 years old, presents with aslight enlargement in his left scrotum

Ultrasound and blood tests are performed.Theblood test indicates high levels of ά-fetoprotein.What is the most likediagnosis?

Back 10

Testicular cancer

Front 11

What are the three tumour markers used

Back 11

ά-fetoprotein (AFP)

HCG

Lactic acid dehydrogenase (LDH)

Front 12

What are the two main classifications oftesticular cancer

Back 12

- Germinal(germ) cell tumours – derived from germ cells

- Nongerminalcell tumours – stromal tumours derived from leydig or sertoli cells

Front 13

What are the two groups of germ cell tumors

Back 13

- Seminomas

- Nonseminomas

Front 14

Describe seminomas

Back 14

- From seminiferousepithelium

- Most commontype of testicular cancer

- 40% ofall germ cell tumours

Front 15

What are the 3 types of non-seminomas

Back 15

- embryonalcarcinoma,

- teratoma

- choriocarcinoma

Front 16

Describe the radiographicappearance of Testicular cancer

Back 16

Uniform, wellcircumscribed, hypoechoic mass without calcification or cysts

Front 17

a male aged 30 years old, presents with aslight enlargement in his left scrotum

On examination the testis feels smooth but with a lump,however there is also a swelling just superior to the testis that feels like a“bag of worms”. What is the diagnosis

Back 17

Varicocele

Front 18

Describethe structure of the spermatic cord and its contents.

Back 18

– External spermatic fascia, Cremasteric fascia (cremaster muscle),Internal spermatic fascia

– Testicular artery, Pampiniform plexus (testicular vein)

– Nerves, Lymphatics

– Ductus deferens

Front 19

a male aged 30 years old, presents with aslight enlargement in his left scrotum

His history indicates an earlier episode ofepididymitis, but no history of recent scrotal trauma or abdominal surgery. Onexamination the enlargement can be transilluminated. This can also develop as a congenital condition What is the diagnosis

Back 19

Hydrocele

Front 20

Describethe neural control of miturition

Back 20

Ø As urine accumulates stretch receptors inthe bladder wall are activated.

Ø Stretch receptors send nerve impulses tothe sacral region of the spinal cord

Ø This results in a nerve reflex whichinhibits the detrusor muscle, keeps the internal urinary sphincter closed andcauses contraction of the external sphincter.

Ø When about 200 mLs of urine has accumulatedimpulses are transmitted to the brain creating the urge to urinate.

Ø If it is convenient to urinate an ‘on/off’switch in the brain called the micturition centre is activated

Ø This centre sends impulses to contract thedetrusor muscle, open the internal sphincter and relax the external sphincter.

Ø Urine flows.

Ø If it is not convenient to urinate the urgesettles temporarily

Ø After another 200 to 300 mL has collectedimpulses are transmitted to the brain again creating the urge to urinate.

Front 21

Describethe structure of the prostate gland (accessory sexual gland)

Back 21

Prostate

– Single doughnut shaped gland about the size of achestnut

– Numerous glands embedded in smooth muscle andconnective tissue

– Ducts open into prostatic urethra

– Fibrous capsule

– Base – against bladder neck

– Apex – against urogenital diaphragm

Front 22

A male aged 65, presents with urinarysymptoms of hesitancy, frequency, a small weak stream and straining to initiateurination.

To confirm suspicions about the cause ofhis urinary symptoms a digital rectal exam (DRE) is performed. An enlargedprostate with a smooth rubbery feel is detected.

What condition of the prostate is mostlikely to be causing his urinary symptoms?

Back 22

Benignprostatic hyperplasia (BPH)

Front 23

Define prostatic hyperplasia

Back 23

Hyperplasia of the para urethral prostategland, commonly seen in med over the age of 50, causing variable degrees ofbladder outlet obstruction

Front 24

Describe the structure of the urinary bladder

Back 24

• Hollow distensible muscular organ

• Located in the pelvic cavity

• Four surfaces and four angles

• Shape: empty = collapsed (pyramid)

slightly full = spherical

distended = pear shaped

• Surfaces

– Superior surface

– 2 x inferolateral surfaces

– Posterior surface (base)

• Angles

– Apex

– 2 x posterolateral angles

– neck

• Structures

– Apex = urachus

– Posterolateral = ureters

– Neck = urethra

Front 25

Describe the internal features of the urinary bladder

Back 25

• MUCOSA

– Transitional epithelia

– Lamina propria

– Rugae = folds of mucosa permitting expansion

• MUSCULARIS

– Smooth muscle = detrusor

– 3 layer

– Circular fibres form the internal urethral sphincter

• ADVENTITIA

– Superior surface = serosa (peritoneum)

Front 26

Describe bladdercompensation due to urethral obstruction

Back 26

· Bladderhypertrophies → ↑ sensitive to bladder filling → with continuation → furtherhypertrophy of bladder muscle → thickening of bladder wall. → ↑ force needed to expel urine → musclefatigue → stagnation of urine →. ↑frequency of voiding → develop diverticula → stasis → secondary infection →hypertrophy of trigone. → ↑ backpressure on ureters → hydroureters → hydronephrosis.

Front 27

a middle aged male, presents with acute onset of urinary frequency, urgency and dysuria. On further questioning he reveals, among other things, he is also experiencing muscle and joint pain. What is a possible diagnosis?

Back 27

ACUTE BACTERIAL PROSTATITIS

Front 28

Describe acute bacterial Prostatitis

Back 28

an inflammatory disorder of the prostate gland caused by pathogens (80% e.coli)

Front 29

what are the general clinical manifestations of acute bacterial prostatitis

Back 29

Urethral discharge, fever, chills, malaise

Front 30

What are the 4 parts of the male urethra

Back 30

Urethra
prostatic urethra

Membranous urethra

spongy urethra

Front 31

describe the male urethra

Back 31

– Terminal part of the reproductive system
– Passage for semen & urine
– 20 cm long

Front 32

describe Prostatic urethra

Back 32

2-3 cm long through prostat

Front 33

describe Membranous urethra

Back 33

-1-2 cm long
-Through urogenital diaphragm (muscular portion between ischial & pubic rami)

Front 34

describe spongy urethra

Back 34

- 15 cm long

-Through corpus spongiosum from the bulb of the penis to the glans

-External urethral orifice

Front 35

what findings may be expected on a digital rectal examination for acute bacterial prostatitis

Back 35

Prostate swollen, tender, warm and soft areas, pus discharge

Front 36

what is the most likely causitive agent for acute bacterial prostatitis

Back 36

E.coli (80%)

Front 37

what is the recommended treatment for acute bacterial prostatitis

Back 37

Bed rest, antipyretics, and analgesics

Front 38

what is the complication that is most important to avoid for a patient with acute bacterial prostatitis

Back 38

Prostate abscesses - usually small → may rupture in several directions. Subsequent fibrosis may follow with urethral obstruction.

Front 39

A male aged in his late sixties, presents with mild constant back pain, described as “aching”, mild but not unmanageable nocturia with some hesitancy. He has noticed occasionally what appears to be blood in his urine, though he has discounted this as the result of something he has eaten. A digital rectal examination (DRE) is performed. The prostate is found to be nodular and fixed. What do you suspect this man to have?

Back 39

carcinoma of the prostate

Front 40

what are the clinical manifestations of carcinoma of the prostate

Back 40

- majority of cases are asymptomatic

- incidentally discovered on rectal examination
- urinary urgency and frequency; nocturia; hesitancy; dysuria; haematuria; blood in ejaculate; bladder outlet obstruction

Front 41

when examining the patient what are the clinical indications of carcinoma of the prostate

Back 41

prostate is nodular and fixed

bone metastises (if present) characterized by lower back pain

pathological #'s can occur

weight loss
anemia
dyspnea

Front 42

Describe the structure of this accessory sex gland

Back 42

Single doughnut shaped gland about the size of a chestnutNumerous glands embedded in smooth muscle and connective tissueDucts open into prostatic urethraFibrous capsule

Front 43

Describe the pathology of prostate carcinoma

Back 43

• Usually glandular;
• frequent mitosis
• Stromal invasion
• It takes origin from the sub capsular regions i.e. were the glands are found.
• Often the prostate also shows benign hyperplasia, but this is coincidental and not causally related.
• It almost always is adenocarcinoma.

Front 44

describe the radiographic appearance on excretory urography of prostate carcinoma

Back 44

Elevates and impresses the floor of the contrast-filled bladder Impression usually more irregular c.f. BPHBladder neck obstruction, infiltration of the trigone or invasive obstruction of the ureters above the bladder may produce obstruction of the proximal urinary tract

Front 45

describe the spread of prostate carcinoma

Back 45

• Direct throughout prostate and surrounding tissue
• Lymphatic spread (main route) → invasion of pelvic lymph nodes → abdominal lymph node chain
• Bone metastasis common (vertebrae) due to retrograde spread from prostatic venous plexus to vertebral veins.
• Bone metastasis, if present, characterized by low-back pain
• Pathological fractures can occur