prostate, seminal vesicles, and bulbourethral glands
Function of the prostate?
primarily forms fluid that supports the sperm along with help from the seminal vesicles
also acts as a valve for the bladder
Function of bulbourethral glands?
add a mucoid secretion ot the semen
male reproductive organs responsible for sperm production
_____ cells in the male genitalia produce and secrete testosterone.
tightly coiled tue that lies along the top of and behind each testis where sperm develop the ability to swim
The prostate is a key organ in the male genitourinary system with obth ___ & _____ functions. I
reproductive and continence
2 phases of ejaculation?
secretions from the periurethral glands, seminal vesicles, and prostate are deposited with sperm from the vasa deferentia and the cauda epididymis into the prostatic urethra
bladderneck or internal sphincter closes and muscles surrounding the blub of the corpus spongiosum contract and propel ejaculate from the urethra and through urethral meatus
What happens to sperm once it is deposited in the vagina?
cholesterol covering the sperm head is slowly lost and membrane of sperm becomes weaker, Ca ions are allowed in and strengthen the swimming of the sperm, enzymes are released to penetrate the zona pellucida of the ovum
Causes of micropenis?
defects in testosterone production
What should pt with micropenis be evaluated for?
How is this tested?
measure serum levels of testosterone, LH, & FSH
How is micropenis treated?
mucosal folds that resemble thin membranes and cause obstruction when a child attempts to void
Clinical manifestations of urethral valves prenatally?
may cause decreased amniotic fluid, incomplete lung development, stillbirth or extreme distress at the time of delivery
decreased amniotic fluid
incomplete lung development
Most frequent manifestation of urethral valves?
inability to void notes shortly after birth with varying degrees of high levels of nitrogen-containing compounds, such as urea, creatinine, various body wastes and renal failure
condition characterized by abnormally high levels of nitrogen-containing compounds, such as urea, creatinine, various body wastes
Manifestations of urethral valve in older children?
UTi, poor stream with straining to void, or occasionally hematuria
Tx of urethral valves?
management of metabolic abnormalities (fluids/electrolytes), treatment o UTI, dranage o urine with a catheter, ablation of the valves with an endoscopic resctoscope
Urethrorectal and vesicourethral fistula causes?
failure of the urorectal sptm to develop completely lead to persistent communication b/t rectum and urogenital tract
Clinical manifestations of urethrorectal and vesicourethral fistulas?
pass fecal material and gas through the urethra and/or urine through the rectum
How are urethrorectal and vesicourethral fistulas diagnosed and treated?
diagnose with radiography and treated with surgery to resct the fistual and open the imperforate anus
urethral meatus is located on the ventral under surface of the penis or on the perineum
What is its relationship to hypospadias?
curvature of the penis
more proximal the hypospadias = more likely it will be accompanied by chordee
Cause of hypospadias?
incomplete fusion of the urethral folds
What should be done in severe cases of hypospadias?
eval for conditions of intersex
Tx of hypospadias?
surgical repair to allow normal urinary stream and sexual function
urethra opens on the dorsal aspect of the penis at a point proximal to the glans penis
Epispadias is related to what congenital condition?
exstrophy of the bladder where abd wall fails to form below the level of the umbilicus
Complications of epispadias?
urine incontinence if the urinary sphincter is affected
Tx of epispadias?
surgical repair more complicated than hypospadias
painful, persistent erection
Cause of priapism?
idiopathic, sickle cell disease, use of anticoagulant therapy, DM, leukemia, and use of antidepressants, impotence treatments, obstruction of venous drainage
What will occur if priapism is not treated?
fibrosis that can cause impotence
Tx of priapism r/t sickle cell?
sedation and oxygen
Tx of priapism not r/t sickle cell?
aspiration of blood from penis and injection of a - adrenergic agents , surgical shunting if other measures do not work
uncircumcised foreskin cannot be retracted
Tx of phimosis?
treat infections with antifungals or antibiotics and circumcision
foreskin that has been retracted over glans up onto the shaft of the penis cannot be replaced in its normal position
What causes paraphimosis?
usually cohronic inflammation under foreskin causes constricting ring of skin to form around the base of the retracted glans causing venous congestion fo the glans with further swelling and edema
Tx of paraphimosis?
reducing the paraphimotic foreskin back over the glans or slit / normal circumcision may be necessary
formation of palpable, fibrous plaque on the surface of the copora cavernosa that causes curvature of the penis with painful, incomplete erections
Tx of peyronie disease?
no good Tx - some meds, procedures to excise plaque and repair defect with graft
fibrotic narrowings of the urethra and are uaually composed of scar tissue
Causes of urethral structures/
usually due to prior infection sucah as gonorrhea or trauma (catheters, straddle injuries)
Clinical manifestations of urethral strictures?
decreased urinary stream, urethral discharge, infection, and urine retention
How are urethral strictures diagnosed and treated?
cytoscopy or radiography that demonstrateds narrowing ot the urethra
procedures to dilate, incise, or reconstruct the urethra
Health conditions ass. with erectile dysfunction
hypertension, high cholesterol, DM, and bad lifestyle
Primary and secondary impotence?
primary - inability to attain an erection throughout life usually r/t psychiatric probs but may be due to vascular trauma sutained in early childhood
secondary - have had an erection but can't anymore
Causes of secondary ED?
peripheral vascular diseae, meds, endocrine probs, trauma, iatrogenic causes, and psych, arterial insufficincy due to arteriosclerosis, DM, excessive venous dranage from the penis
Meds that cause ED?
antihypertensives, phenothiazines antihistamines, and some antidepressants
Endocrinopathy that causes ED?
any disturbance that causes low levels of testosterone: low secretion of LH hormone, excessive secretion of prolactin
Assessments needed to determine the cause of ED?
must first differentiate organic auses from psychogenic causes then find the physical cause if there is one
Tx of ED caused by physical factors?
insertion of inflatble or semirigid prosthtic device into the corpora caernosa, intracavernous injection of vasoactive substances, viagra, levitra, and cialis, vaccum device, procedures to revasculate the penis
Contraindication for ED meds?
not to be used with nitrate meds
Causes and Tx of PE?
may be biological and psychosocial and there are no approved Tx at this time
Neoplasms of the penis?
What is thought to be a primary etiologic factor causing cancer of penis?
phimosis of the foreskin accompanied by chronic inflammation
The majority of penile cnacer cases are ___ ___ ___ and usually occur on the ____ or the inner surface of the ____.
squamous cell carcinoma
How does penile cancer metastasis occur?
lymphatic dissemination with initial involvement of the palpable inguinal lymph nodes
Stages of penile cancer?
I - lesion is limited to glans or foreskin
II - tumor involves shaft of penis
III - inguinal nodes are involved but lesion is operable
IV - disease is disseminated
Manifestations of penile cancer?
lesion that is usually ulcerative and fungating in appearance and may be associated with pain, bleeding, and urethral discharge, inguinal adenophathy may be present
Tx of penile cancer?
depends on stage: topical chemotherapy and radiation therapy for superficial lesions, partial or total penectomy with perineal urethrostomy, removal of inguinal lymph nodes, systemic chemotherapy
congenital condition where testis occupies an extrascrotal position
Cause of cryptorchidism?
unknown - may be due to intrinsic testicular defect or a subtle hormonal deficiency
Complications of cryptorchidism?
fibrotic tubules, deficiency of spermatogenesis with infertility & increased incidence of testicular malignancy
Tx of cryptorchidism?
treat at an early age to bring testis into a normal position - procedure usually required but may use admin of human chorionic gonadotropin by IM injection
surgery to repair cryptorchidism
an acquired disorder that causes androgen deficiency in the aging male
Causes of hypogonadism?
usually primary testicular failure
S/S of hypogonadism?
ED, loss of muscle tone, osteoporosis, and lipid metabolism changes, metabolic syndrome
Diagnosis of hypogonadism?
serum testosterone, prolactin, and LH levels
Tx of hypogonadism?
Pt receiving testosterone therapy need to be monitored for ___ ____ and ______.
prostate cancer and polycythemia
fluid collection surrounding the testicle or spermatic cord and contained withing the tunica or processus vaginalis
How may hydrocele be indicated in infants or young boys?
Tx of hydrocele?
if fluid becomes uncomfortable or restricts blood flow may drain the fluid and resection or plication of the hydrocele sac to prevent reaccumulation of fluid or aspirate fluid
painless, cystic masses containing sperm
Tx of spermatoceles?
procedure to excise the spermatocele
twisting of the spermatic cord with subsequent compromise of testicular vasular supply and testicular ischemia followed by infarction
What age group does teticular torsion most occur in
Clinical manifestations of testicular torsion?
severe pain in one testis, followed by swelling of the scrotum, lower abd pain accompanied by N/V,
How is testicular torsion differentiated from epididymitis?
ultrasound, ischemia present in torsion,
Lab testing for male infertility?
2 semen analyses that show sperm concentration& number, motility, and morpholigy
med history and assessment
Tx of male infertility?
procedures that correct morphological issues that restrict sperm flow, hormone therapies, intrauterine insemination or in vitro fertilizaiton
inflammation of the testis
Causes of epididymitis?
trauma, reflux of steril urine up the vas deferens, bacterial causes / STI's
Clinical manifestations of epididymitis?
inflamed scrotum with pain that may radiate along the spermatic cord into the inguinal area, fever, urethral discharge, cystitis, cloudy urine, elevated WBC count and bacteria in urine
Tx of epididymitis?
bed rest, scrotal support, and admin of anitbiotics
incision and drainage in extreme cases or removal of testicle
severe condition involving gangrenous necrosis of the scrotum
S/S of fournier gangrene?
pain and swelling of the scrotum, fecver, chills, and sepsis
What may predispose a person to fournier gangrene?
DM, alcoholism, or other debility
What may be the source of infection that causes fournier gangrene?
extravasation of infected urine from urethral trauma, perforated urethral diverticulum, non-urinary tract source such as perirectal abscess
Tx of fournier gangrene?
incision and dranage and debridement of necrotic tissue, admin of antibiotics
What is the most important factor in Tx of fournier gangrene?
fast Tx or death can occur
The most common solid tumors of US men ages 20 t0 34 years are caused by?
Causes of testicular cancer/
strong ass. b/t cryptochidism and malignancy, other factors are unknown
2 groups of testicular cancer?
nongerminal neoplasms - tumores that originate from the leydig cells or other stromal tissue cells of the testis
germinal neoplasms - derived from the germinal cells of the testis
Stages of testicle cancer?
I - tumor is confined to the testis
II - tumor has spread to retroperitoneal lymph nodes
III- tumor has spread to nodes above the diaphragm
IV - tumore has spread to other organs
Tx of testicular tumor
removal of the testicle and possible lymph nodes associated
benign prostatic hyperplasia - hyperplasia of the glands surrounding the prostatic urethra that compresses the urethra and produces symptoms of bladder outlet obstruction
What is main cause of benign prostatic hyperplasia?
Clinical manifestations of BPH?
may progress to complete obstruction and urinary retention, decrease in force of urinary stream, hisitncy or difficulty initiating stream, and interruption of stream, UTI due to bladder not emptying completely
Tx of BPH?
first line of Tx is with meds to decrease tnesion in prostate by relaxing the muscle fibers in the gland and reducing presssure in the bladder neck and urethra (a - blockers) or meds that decrease size of the gland by blocking the conversion of testosterone to dihydrotstoterone and shrinking the gland (5a-reductase inhibitors)
next line of Tx are minimally invasive office procedures not very successful
last Tx is surgery TURP or laser to remove excess tissue that is blocking flow
inflammation of the prostate
4 types of prostatistis?
acute bacterial, chronic bacterial, nonbacterial, and prostatodynia
Causative organism in bacterial prostatitis is usually ___ ___.
Clinical manifestations of acute bacterial prostatitis?
fever, chills, low back pain, voiding frequency, urgency, and dysuria, tnder, swollen prostate, and WBC & bacteria in urine
Difference in S/S of chronic bacterial prostatitis and acute?
chills and fever usually do not occur in chronic
Differnece in S/S of nonbacterial prostatitis and bacterial prostatitis/
no bacteria or WBC in urine,
symptoms of prostatis but no hiostory of urinary tract infeionandno evidence of inflammation in prostatic scretions
What age men are most at risk for prostate cancer?
50 and up
Stages of prostate cancer?
1 - tumor is microscopic and intracapsular
2. - tumor is palpable on rectal exam but confined to the prostate
3 - tumor has extended beyond the capsule of the prostate
4- tumor has metastasized to distant organs
If a pt has symptoms from prostate cancer what does this indicate?
no Tx because the symptoms usually indicate extensive disease
S/S of advanced prostate cancer?
hematuria, weght loss, malaise, anorexia, and back pain
Tx of prostate cancer?
removal of prostate and surrounding tissue, radiation therapy, removal of pelvic lymph nodes, hormonal manipulation,
What is considered the first day of the menstrual cycle?
the first day of menstruation
When does ovulation occur?
in the middle of the menstual cycle (14 days in )
Menstrual cycle process?
on day one the thickened layer of the endometrium is sloughed off and 35 mL of blood is lost as FSH is released by pituitary gland and stimulates a goup of follicles to develop in the ovary -> preovulatory phase where theca and granulos cells in developing follicles in ovary serete estrogen that stimulates growth of the uterine endmetrium again -> at midpoint of cycle increase in estrogen secretion from follicles occurs -> anterior pit more responsive to LH and produces a burst of LH and FSH lvel also increases -> rapid swelling of follicle and ovulation-> postovulatory pahse - site of the ruptured follicle becomes corpus luteum which secretes estrogen and progestoerone and thicken uterine endometriu
If fertilization of the ovum occurs the embryo arrives in the uterus on about the ___ day of development and on about the ____ day of fertilization the embryo implants itself in the endometrium and development of the ___ occurs.
What does the placenta secrete that signals the corpus luteum to continue to function?
human chorionic gonadotropin hCG
What stimulates the brast to develop glands and ducts for lactation?
progesterone and estrogen released from the corpus luteum and placenta
What happens to breast ducts in the first & second trimester of pregnancy?
first - proliferate
second - group together to form large lobules with new alveoli formation
What occurs in breasts at the end of the third trimester?
alveoli dilate in prepartation for lactation and at end of pregnancy and until 1 to 3 dyas after childbirth mamary glands form colostrum
What does colostrum contain?
protein and lactose but little fat
What stimulates milk production?
prolactin from the anterior pituitary gland and oxytocin from the posterior pituitary gland
Fertilization of the ovum occurs in the ____. Withing 24 hours after fertilization what occurs?
zygote begins a series of divisions by the process of mitosis called cleavage
What occurs as cleavage takes place?
embryo is transported through the oviduct until it arrives at the uterus on day 4
Where does embryo receive nutrition on days 4 - 7 of fertilization?
secretions released by the endometrial glandsstimulated by progesterone
When doe implantation occur
day 7 after fertilization occurs
2 basic functions of the placenta?
1. exchange b/t developing fetus and themother
2. endocrine organ that produces several hormones
Important hormone secreted by the placenta?
hCG - human chorionic growth hormone
Which hormone during pregnancy is responsible for inhibiting contractility of the uterus? What is the purpose of this?
prevents spontaneous abortion
Why is hCG needed for pregnancy?
Where is it secreted from?
it signals the corpus luteum that a pregnancy has occured and causes it to continue secreting hormones that keep endometrium in place
fertilization to the end of the eight week
ninth week until birth
What occurs at 36 hours from fertilization?
embryo has achieved 2-cell stage
By 2.5 weeks fertilization the ___ & ___ ___ are formed and will eventually give rise to the ___ ____ ____. The tissue that will form the ____ has differentiated also.
notochord and neural plate
When will the heart be beating and the primary vesicles of the brain be formed?
by the end of the first month
When do the gonads start to develop into male or female?
around the seventh week
What causes male and female differentiation?
presence of dihydrotestosterone causes male genitalia to form and absence causes female
What occurs in the second month of development?
embryo becomes capable of mevement, major blood vessels assume final postions, heart assumes final shape, brain begins to transmit impules to regulate function of organ systems, and a few reflexes are present, rudiments of all organs are present
What occurs during the third month of development?
ears and eyes approach final positions, some bones become distinct, fetus performs breathing movements, sucking movements,
What occurs during the second trimester?
fetus achieves independent mobility, heartbeat is audible with stethoscope,
What occurs during third trimester of development?
weight almost doubles in last 2 months, final differentiation of tissues and ogans takes place,
process by which the infant is born
Hormonal changes that cause labor?
estrogen increases while progesterone stays or decreases - estrogen increases uterine contractions and progesterone decreases them
oxytocin is secreted and causes uterine contraction
Changes in metabolism during pregnancy?
BMR increases by 15% and affects other organ systems
Changes in reproductive organs during pregnancy/
all are enlarged
Changes in circulatory system during pregnancy?
increase in blood volume and metabolism causes increase in maternal cardiac output by week 27 of pregnancy -
cardiac output decreases to a little above normal during last 8 weeks of pregnancy
What causes increase in blood volume of pregnancy?
increase in aldosterone and estrogens promote increased fluid retention by the kidnesy and bone marrow increases its activity to produce excess RBC
Changes in respiratory system during pregnancy?
increased BMR and size reult in increase in O2 utilization wit net result of increase in minute ventilation and a decrease in arterial PCO2 to slightly below normal
Changes in urninary system of pregnant?
increaed load of excretory products = increased rate of urine produduction
renal tubule reabsorption of Na, Cl, and water is increased due to production of steroidal hormones by the placenta and adreanl cortex
glomerular riltration rate increases to increase rate of water and electrolyte loss in urince to balance out water increases
What occurs in the urinary system with toxemia?
excess water and salt accumulation with life-threatening consequences
Avg weight gain during pregnancy?
What vitamin helps prevent neural tube defects in the developing fetus?
Whe does menopause occur?
about 45-52 years
absence or suppression of mensration in a female age 16 or older
missing 3 or more periods
failue to begin menses by age 16
cessation of est regular menstrutaiton for 6 months or longer
Causes of amenorrhea?
abnormal hormonal functioning, physical or emotional stress, neoplasms of the ovaries or adrenal and pitutiray glands
Tx of amenorrhea/
hormonal supplementation, surgery for tumor removal
Metrorrhagia and its causes?
bleeding b/t menstrual perids
usually from slight physiolgic bleeding from the endometrium during ovulation
may be due to uterine malignancy, cervical erosions, and endmetrial plyps or estrogen therapy
deficient amnt of menstrualflow
endocrine systemic disorders, partial obstruction of menstrual flow by the hymen or narowing of cervical os
usually failure to ovulate b/c of endocrine sytemic disorder
increased frequency of menstruation
associated with ovulation and may be caused by endocrine or systemic factors
often debilitating increase in amount or duration of menstrual bleeding
usually from lesions of the female reproductive organs
dysfunctional uterine bleeding?
When is it most common?
abnormal endometrial bleeding not associated with tumor, inflammation, pregnancy, trauma, or homrnal effects
around menarche and menopause
menstruation that is painful enough to limit normal activity or to cause a woman to seek health care
not r/t any identifiable patholigic condition
r/t an underlying patholigic condition
Tx of dysmenorrhea?
ibuproen and naproxen for pain and to inhibit prostaglandin-induced uterine contractions that cause pain
steroid hormones / oral contraceptives
descent of the uterus due to supporting structures relaxing
Complication of uterine prolapse?
pressure of abd organs on the uterus will force it downward through the vagina into the introitus
Usual cause of uterine prolapse in infants and ppl who havent given birth?
Usual cause of uterine prolapse in women who have given birth?
trauma to the ligaments druing childbirth
Who is most at risk for uterine prolapse?
women who have delivered multiples
S/S of uterine prolapse?
1st degree - sensation of bearing down and sicomfort in vagina
2nd or 3rd degree - discomfot while walking or sitting and difficulty urinating, cervix protuding outside the body with friction and ulceration and bleeding of ulceration
Tx of uterine prolapse?
pessary - small supportive device inserted to hold the uterus in place
Retrodisplacemnt of the uterus?
body of the uterus is displaced from its usual locatin overlying the bladder to a position in the posterior of the pelvis
Manifesttions and Tx of retrodisplacement of the uterus?
may be asymptomatic, pelvic pain or pressure, dysmenorrhea, and painful intercourse
Tx with pessary or surgical correction with laparoscopy
protrusion of a portion of the urninary bladder into the anterior of the vaina at a weakened part of the vaginal muculature that causes the vaginal wall to bulge in a downward direction
What causes cystocele?
weakening of an area of the vaginal wall due to injury during childbirth or surgery or again process
Predisposing factors for cystocele?
obesity and history of lifting heavy objects
Manifesations and Tx of cystocele?
sensation of pressure in vagina, dysuria, incontinence, and back pain, fullness at the vag opening,
surgical repair and placement of bladder
protursion of the anterior rectal wall into the posterior of the vagina at a weakended part of the vaginal muscualture
Causes of rectocele?
same as cystocele
Predisposing factors to rectocele?
obesity, multips, postmenapausal
Complications of rectocele?
retum may be torn from its fascial and muscular attachment to the pelvic wall
Manifestations and Tx of rectocele?
difficulty in BM, chronic constipation, pressure, painful intercourse,
pelvic inflammatory disease - any infection of the oviducts and ovaries with involvement of the adjacent reproductive organs
PID with connective tissue involvement
S/S of PID and associated problems?
chronic pelvic pain, dsypareunia, pelvic adhesions, chronic inflammation andabscesses of the oviducts
infertility, ectopic pregnancies
Causes of PID?
caused by bacterial infections introduced by procedures, abortions, and other infections that spread to this area
2 most common causitive agents for PID?
Neisseria gonorrhoeae and chlamydia trachomatis
S/S of PID?
abd tenderness, cervical pain or adnexa on palaption, fever, WBC elvated, pelvic abxcess, inflammatory mass, purulent vag discharge
Tx of PID?
Life-threatening complication of PID?
rupture of pelvic abscess
total abd hysterectomy and bilateral salpingo-oophorectomy
inflammation of the vulva and vagina
Causes of vulvovaginitis?
infection by candida albicans, trichomans vaginalis, haemophlus vagninalis, and n. gonnorhea