System Path II - Male GU & Reproductive System

What is due to abnormal embryogenesis of the urethral orifice, which typically are surgically reconstructed?

Congenital malformations of the urethral orifice

What is it called when the urethral orifice abnormally develops on the ventral surface of the penis; opening is always within the midline of the penis, 90% occur near the glans, and has increased risk for other congenital malformations like Cryptorchidism?

Hypospadias

1/300 live births

What is it called when the irethral orifice abnormally develops on the dorsal surface of the penis, is more severe and often associated w/ additional malformations liike Exstrophy of the urinary bladder?

Epispadias

1/100,000 live births

What is an acquired condition where fibrous plaque forms on the penis, causing curvature and pain?

Peyronie's Disease

Chordee is a ______ conditions from abnormal development of the penis in abt 1/200 lives births; leading to a ______ curved penis that is not notiable during erection and is often associated w/ _______

congenital; downward; hypospadias

_____ epispadias is found on the glans of the penis; ______ epispadias is found along the shaft of the penis; _______ epispadias is found or near the pubic bone

glandular; penile; penopubic

What is a spectrum of GU malformations that calssifies different levels of severity?

Bladder-exstrophy-epispadias-complex (BEEC)

What is an "inside-out" bladder the proturdeds out of the abdomen and inside of the bladder is exposed to outside environment?

Bladder Exstrophy

What is itching, swelling, redness, and pain of the penis? What are the causes?

Penile & Prepuce Inflammation

- Poor hygiene: accumulation of smegma

- Infxn: fungal/bacterial/viral

- Allergic contact dermatitis: irritation or psoriasis/eczema

- Trauma/injury

Balanitis

inflammation of the glans penis

Posthitis

Inflammation of the prepuce (foreskin)

Balanoposthitis

inflammation of the glans and prepuce

Phimosis

condition where tightening or narrowing of the opening of the prepuce and is unable to be retracted

______ phimosis has naturally tight foreskin that loosens as the child grows (resolves by age 17); _____ phimosis is due to infxn, trauma, inflammation, or scarring following Balanitis, Posthitis, or Balanoposthitis

congeital/physiologic

pathologic/acquired

Paraphimosis

when prepuse becomes trapped in the coronal suclus of glans (cannot un-retract)

Paraphimosis is a urologic _____ bc is can cut off _____ supply to the glans leading to pain, swelling and _____

emergency; blood; necrosis

What are causes of Paraphimosis?

Latrogenic - medical professions or caregiver retracts foreskin during procedures (catheter placement) and forgetting to return it to the natural state

Other - balanitis due to fibrotic changes or inflmmation/infxn

Balanitis, Posthitis, or Balanoposthitis could all lead to what?

Phimosis or Paraphimosis

What represents <1% of all cancer Dx in males where 95% are squamous cell carcinomas? What are risk factors?

Penile tumors

- >40 yrs, uncircumcised, phimosis (50% of cases)

- smoking (3x), poor hygiene, livig in developing countries, HPV-16 or 18

What is a stage 0 squamous cell carcinoma in any location; insitu SCC is solitar red plaque on gland or prepuce, and 90% remain localized (10% invasive)?

Bowen Disease

What is at least stage 1 SCC w/ grey, crusted, hardened raised appearance that becomes more invasive and produce an ulcerated appearance or inflamed penile lesions that fails to heal or as wart-like growth? Metastasis? Tx?

Penile Invasive SCC

- Yes, lymphatic mets

- Tx = excision, chemo, radiation, penectomy

T/F In Penile cancer, delay increases risk of Tx

TRUE

Inflamation of the scrotum is caused by what?

infxns or dermatological

What is rare pathology of scrotum where SCC is the MC; AKA chimney sweep's cancer?

Scrotal cancer

What is due to increased serous fluid in tunica vaginalis, is the MC cause of scrotal enlargment, cause may be infxn, tumor, laproscopic surgery, or idiopathic, and transluminescence is used for Dx?

Hydrocele

_____ is accumulation of blood in the scrotum usually due to trauma or advanced testicular cancer; _____ is accumulation of lymph and FAs (chyle)

hematocele; Chylocele

What is a group of tropical diseases caused by various thread-like parasitic round worms and their larvae that transmit the disease to humans through mosquito bites leading to fever, chills, HA, skin lesions?

Filasiasis

- if left untreated, can lead to enlargment of limbs or genitals

What is failure of the testicle to descend from abdomen into scrotum, is MC idiopathic, associated w/ congenital inguinal hernias, and has a 3-5x increased risk for testicular cancer (germ-cell tumors)? What are risk factors?

Cryptochidism

- low birth weight, premtaure birth, intrauterine exposure to endocrine disrupting chemicals, or idiopathic

If a infant males mother took DES during pregnancy what pathologies could the infant experience?

Cryptochidism, Epididymal Cysts, Micropenis, Reproductive Issues

What are causes of testicular atrophy? What is this condition associated w/?

chronic testicular ischemia to ionizing radiation, physical trauma, cryptochidism, exposure to chemotherapy meds and anabolic steroids, elevated estrogen

- associated w/ infertility or sterility

What is swelling/inflammation secondary to viral (mumps) or bacterial (STI) infxn, leading to pain, swelling, tenderness, fever, redness, warmth, burning during urination,a nd frequent urination?

Internal scrotal inflmmation

- Testis = orchitis

- Epididymis = epididymitis

What commonly begins as UTI that spreads to teste via vas deferens or lymphatics and causes acute onset, edema, and tenderness? What the the causes at certain age groups?

Orchitis

- prepubertal males and older males = E. coli or Mycobacterium TB

- Sexually active males under 35 = Neisseria gonorrhoeae or Chlamydia trachomatis

Orchitis can be caused by what viral infxns?

Mumps virus: 20% of adult orchitis; necrosis to sterility

TB: caseous granulomas

Autoimmune: anti-sperm Ab (ASAs)

What is an urologic emergency of spermatic cord twisting tha obstructs venous drainage leading to severe scrotal congestion and various degrees of obstruction of arterial blood supply, acute engorgement and pain?

Testicular Torsion

_____ torsion occurs in utero or perinatal (rare), has no anatomical deformity, infarction, and extravaginal torsion (perinatal testicular torsion); _____ torsion is MC at age 12-18, Bell-clapper deformity, and intravaginal torsion

neonatal; adult

What reflex is used to Dx testicular torsion? What is Tx?

absence of cremastic reflex

- 1/3 spontaneously resolve

Tx: surgical repair is unresolved within 6 hrs; 3/4 need orchidectomy if surgery delayed for more than 12 hrs

_____ sign is used to determine cause of testicular pain by lifting half of the scrotum; exacerbation of pain is a _____ test meaning testicular torsion may be present; relief of pain is a _____ test meaning acute or chronic epididymitis may be present

Prehn's; Negative; Positive

What is enlarged pampiniform venous plexus of the scrotum ("varicose veins"), occurs in 20% of adults males, a common cause of low sperm production and decreased sperm qualit, which can lead to infertility; and is MC on the left?

Varicocele

What are the 3 theories of anatomical causes of varococele?

1) failure of antireflex valvue where the internal spermatic vein joins the left renal vein (cause reflux and retrograde flow in testicular vein)

2) angulation at juncture of left internal spermatic vein adn left renal vein --> increasing hydrostatic pressure on left side

3) "Nutcracker" effect which occurs when the left internal spermatic vein gets caught btw the superior mesenteric artery and aorta leading to venous compression adn spermatic vein obstruction

What are risks for varicocele? Should you consider malignancy?

vascular defects and family Hx

- Yes, testicular or renal cell carcinoma (RCC: isolated right-sided varicocele)

- a large RCC can compress the left renal vein and impede normal venous drainage of left testicle

What is the avg age for testicular cancer Dx?

33

What are risks for testicular cancer?

Family Hx

cancer in cantrlateral testicle

cryptorchidism

caucasians

gonadal dysgenesis

androgen insensitivity

biopsy is risk for complication from tumor spillage

What are S/S of testicular neoplasia?

lump or enlargemtn fo either testicle

feeling of heaviness in scrotum

dull ache in abdomen or groin

sudden collection of fluid in scrotum

pain or discomfort in testicle or the scrotum

enlargment or tenderness of the breasts

back pain

T/F the two main types of testicualr tumors are germ cell and non-germ cell

TRUE

What are a majority of testicular tumors that and are malignant? What are the subtypes?

Germ Cell Tumors (GCT)

- Seminomas

- Mixed germ cell tumors

- Nonseminomas

______ are 50% of GCTs, has a favorable prognosis, occur in those aged 30-40, is a soft, localized mass, with increased levels of hCG; _________ is 50% of GCTs, are more aggressive w/ poorer prognosis, smaller and difficult to palpate, and mets sooner

seminomas; nonseminomas

Seminomas distinct _______, lack anaplastic changes, and are less aggressive, the cells have a large _______ cells w/ adundant clear cytoplasm and large nuclei; they are _______ so they can often be cured

borders, round; radiosensitive

Which type of Nonseminoma is a firm mass, occurs in all ages, and has NO tumor marker?

teratoma

Which type of Nonseminoma is invasive, anaplastic, has indistinct borders, grows rapidly, spreads outside the testicle, ossurs in those aged 20-30, and has increased AFP and hCG?

Embryonal Carcinoma (40%)

Which type of Nonseminoma is a small mass that spreads quickly to lungs, brain, bones; occurs in those aged 20-30, has increased hCG, responds poorly to radiation and chemo, and is usually requires a radical orchiectomy?

Choriocarcinoma (rare)

Which type of Nonseminoma is large, anaplastic, occurs in 3 yrs old, has favorable prognosis, and has increased AFP?

Yolk Sac Tumor

What are simialr features btw Seminomas and Nonseminomas?

painless testicular mass, non-translucent, blood insemen, dull achy pain in groin/abdomen

What are 5% of testicualr tumors that are benign? What are the two types?

Non-germ cell or sex cord-stromal tumors

- Leydig & Sertoli cell tumors

Leydig Cell tumors are derived from testicular stroma and lead in elevated _____, histologically appears as ______ ____ ____ and is typically associated w/ precocious puberty in children and gynecomastia in adults

angrogens (testosterone); intracytoplasmic Reinke crystals

Sertoli cell tumors are derived from sertoli cells or a mixture of sertoli and _______ cells, which secrete both _____ and ______, leading to enlarged ______ glands

granulosa; androgens; estrogen; mammary

Who should you refer a Pt to is suspecting testicualr mass? Why?

Urologist

- specialize in male and female urinary tract and reporductive system of males

What are the 3 zones of the prostate gland?

Central, Peripheral, Transitional

the ____ zone surrounds the ejaculatory duct; the ____ zone is the largest and MC site for prostate cancer to start, and is easily felt by doctor in DRE; the _____ zone surrounds the urethra

central; peripheral; transitional

What is swelling and inflammation of the prostate gland in 50 yr or younger? What are S/S?

Prostatitis

- pain or burning sensation when urinating (dysuria)

- difficulty urinating

- frequent urination, specifically at night (nocturia)

- urgent need to urinate

- cloudy or blood in urine

- pain in abdomen, groin, or back

- pain or discomfort of penis or testicles

- painful ejaculation

- flu-like S/S (bacterial)

What is the #1 cause of prostatitis that leads to LBP, pelvic pain, dysuria, fever, chills, tender DRE? What are pathogen routes?

Bacterial Prostatitis (acute and chronic)

- blood, lymph, urethra/bladder, rectum

T/F the MC bacteria to cause bacterial prostatitis is chlamydia trachomatis

FALSE

- E. coli is the MC

What are DDx for acute bacterial prostatitis?

benign prostatic hypertrophy, chronic bacterial prostatitis, chronic pelvis pain syndrome, cystitis, diverticulitis, epididymitis, orchitis, proctitis, prostate cancer

What is pain in the prostate/pelvic area w/ no evidence of infxn or inflammation? What are S/S?

Chronic Non-bacterial prostatitis (prostatodynia/chronic pelvis pain syndrome)

- pain upon urination

- urinary voiding difficulties

- sexual dysfxn

In a Pt w/ Chronic Non-bacterial prostatitis, how might a urinary samle appear? What is Tx for this Pt?

only WBC present and no bacteria

- some cases have no bacteria or WBC

Tx: antibiotics, anti-inflammatory, alpha blockers

What is hyperplasia of the transitional zone, has idiopathic cause, onset occurs in those >40 and is present in 90% of males >70, and only 10% of cases are symptomatic?

Benign Prostatic Hyperplasia

What is the average age for Dx of prostate cancer? What are S/S?

66

- may be asymptomatic early on

- trouble urinating, decreased force in stream of urine, blood in urine or seman, bone pain, losing weight w/o trying, erectile dysfunction

What are risk factors for a carcinoma of prostate?

>50 yr, increased androgens, genetic mutations, family Hx, BRCA 1&2 gene, obesity, race

Majority (80%) of prostate carcinomas occur in the _____ zone, involes increased ___, and _______ mets to the spine, which appears as what signs on imaging?

peripheral; PSA; osteoblastic; Ivory vertebra sign

What is PSA?

Prostate-specific antigen

- protein produced b both cancerous (malignant) and noncancerous (benign) prostate tissue

What is Tx for prostate carcinomas?

watchful waiting, radiation therapy (seed), prostatectomy, anti-androgen therapy

What is dialtion of the renal pelvis/calces due to obstruction, leading to blocked urine (dilation), atrophy and decreased function, and has a sudden or gradual onset?

Hydronephrosis/Swollen Kidney

_____ hydronephrosis is MC in males due to atreasia of ureter or urethra, hypoplasia of renal pelvis, and mass compressing on ureter; ______ hydronephrosis can be unilateral or bilateral, due to stone, BPH, prostate CA, prostatitis or urethritis, uterine or cervical cancer, bladder cancer, neurogenic paralysis of bladder, or following normal pregnancy

congenital; acquired

What is untreated hydronephrosis lead to? What does Tx depend on?

progessive renal atrophy

- cause

______ calculus is MC, made of ____ _____ in the renal pelvis/calyces, and usually pass within 4 wks or w/ lithotripsy. What are risk factors?

renal; calcium oxalate

- males (3x increased risk), family Hx, dehydration, UTIs, decreased vit A, gout, diet of high oxalates

_____ calculus are upper ______ tract stones that form a cast over the renal pelvis and is made of magnesium, ammonium, and phosphate

staghorn; urinary

T/F staghorn calculi are associated w/ recurrent STDs

FALSE

- recurrent UTIs

Deficiency of vit A leads to _______ and bitots spots. What does toxicity lead to?

kidney stones; vomiting/weight loss, arthritis, HA, dizziness/stupor, diplopia

What stones are referred to as "infection stones" because of their stong association w/ UTIs?

Struvite stones

Bladder calculi are due to urinary _____, are common in elderly males and could lead to bladder carcinomas

stasis

What is an envagination of the bladder wall, that is MC acquired, small, and asymptomatic, and has an infxn risk?

bladder diverticulum

What is inflammation of the urinary baldder, which can be caused by bacterial infxn, chemo/radiation, trauma, poor hygiene, DM, age, comprised immune system, or lack of urination. What are S/S?

Cystitis

- urinary frequency/urgency, suprapubic pain, dysuria, hematuria, dyspareunia

What is the MC type of bladder cancer? What are risk factors for bladder cancer?

urothelial carcinoma (transitional cell carcinoma)

- age 50-80, males, bladder irritation, smoking, industrialized/urban environemnts, occupational carcinogens, acquired TP53 or RB mutations

T/F bladder cancer can be either invasive or non-invasive

TRUE

_____ carcinomas are slender, finger-like projections from inner surface of bladder and grow toward the ______ w/o growing into the _____ layers of the bladder. _____ carcinomas do not grow towad the center of the bladder

Papillary; center; deeper; flat

What is it called when a papillary or flat carcinoma only grows into the inner layer of the bladder? What if they grow into deeper layer?

noninvasive or in situ

invasive

What are S/S of bladder cancer? What happens when a Pt stops smoking?

painless hematuria (gross), changes in bladder habits, high recurrence

- decreased risk of progression and risk of recurrence

What is the MC STD in the US, that has more than 40 strains and can spread through direct contact via oral, genital, or anal?

Human Papillomavirus (HPV)

Which HPV strains cause acuminata? Which HPV strains cause squamous cell proliferations, pre-neoplastic lesions and is associated w/ cervical, anal, and oropharyngeal cancer?

HPV-6 & 11

HPV-16 & 18

What is the MC bacterial STD in the US, where females are usually asymptimatic and males experience painful urination and pus discharge? What can this condition stimulate?

Chlamydia

- can stimulate reactive arthritis (Reiter's syndrome)

- +HLA-B27 (can't see, can't pee, can't dance w/ me)

What is a parasitic infxn that occurs 5-28 days after exposure and is commonly asymptomatic in males and females experience itching or burning during urination and yellow/green frothy discharge?

Trichomoniasis (trich)

What STD can spread throughout the body, is asymptomatic in females and males have extremly painful urination and yellow/green discharge, can be a transcervical infxn, and cause neonatal conjunctivitis? What is Tx?

Gonorrhea (the clap)

- siler nitrate or antibiotics in newborns eyes

What STD can be spread vaginal, anal, oral, or transplcental, flu-like symptoms 2 wks after exposure, lesions look like blisters, which are filled with fluid & virus?

Herpes Simplex Virus (HSV-2)

What are histological features of HSV?

multinucleated giant cells w/ viral inclusions

- Utilize a Tzank Smear

What are the 3 stages of Syphilis? Tx?

primary, secondary, tertiary

- Penicillin C (primary & secondary)

_____ syphilis is characterized by chancre (painless); ______ syphilis is cahracterized by palmar rash, lymphadenopathy, and condyloma latum; _______ syphilis is characterized by neurosyphilis, aoritis, and gummas

primary; secondary; tertiary

What type of syphilis is due to transplacental spread, where the mother is the carrier, is part of standard pre-natal screening, and if left untreated has a 40% lethality in utero?

congenital syphilis

______ has widespread bone/visceral destruction; ______ is cutaneous, visceral, skeletal, has hepatomegaly, pancreatic fibrosis, pneumoitis, and endarteritis; ______ occurs 2 yrs after birth and has facial, dental, skeletal/periosteal abnormalities

stillbirth; infantile; tardive

What are characteristic features of congenital syphilis?

saddle nose deformity, mulberry molars, joint swelling, bowing or thickening of tibia, and Hutchinson teeth

What is asymptomatic for years w/ fever/flu-like symptoms 2 wks after exposure and causes a decrease in WBC?

HIV

Does HIV mean someone has AIDs? How can one distinguish?

No

- ELISA and Western Blot tests