Term
| What are the 4 stages of male arousal? |
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Definition
Excitement
Plateau
Orgasm
Resolution |
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Term
| What is the definition of ED? |
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Definition
| Consistent inability to get or maintain an erection enough to perform intercourse |
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Term
| What vein is important for maintenance of erection? |
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Definition
| Occlusion of the dorsal vein |
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Term
| What are 4 steps for the attainment of an erection? |
|
Definition
- Relaxation of cavernosal smooth muscles
- Increased blood flow to cavernosal sinuses
- Penile engorgement
- Compression of the venules by the cavernosum, restricting outflow
**if these steps are happening, PNS is working |
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Term
| What is the primary mediator of smooth muscle contraction? |
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Definition
Calcium! PgE1 --> PKA pathway, calcium does not come in and SM relaxes. Allows for blood flow and erection
SNS - anti-erectile |
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Term
| What roles do PDE5 and NO play in erection? |
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Definition
NO allows for vasodilation and cGMP synthesis
PDE5 breaks down cGMP, want to inhibit this enzyme. |
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Term
| What are the 5 etiologies of erectile dysfunction? |
|
Definition
- Psychogenic - Stress, depression, etc
- Neurogenic - Failure to initiate nerve impulses such as stroke
- Endocrine - Hypogonadism
- Vascular - HTN, smoking
- Drug induced |
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Term
| What is the artery size hypothesis of ED? |
|
Definition
Vascular occlusion contributes to ED.
Symptomatic at 50% |
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Term
| What is the role of testosterone in ED? |
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Definition
Testosterone promotes libido
Spontaneous nocturnal tumescence
Required for NO expression, increased expression of PDE5, maintains corp. cav. avoiding lipodystrophy. |
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Term
| Where is the prostate gland located? |
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Definition
| Anterior to the rectum, below the bladder, surrounds the urethra. |
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Term
| In what zone does BPH originate? |
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Definition
| The transitional zone, closest to the urethra. |
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Term
| What are the 2 different types of tissue in the prostate? |
|
Definition
- Stromal tissue - controls SM contractions via alpha1 receptors - more prominent in BPH
- Epithelial tissue - produces fluid, androgen sensitive. Sensitive to DHT |
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Term
| What are the 2 components of disease in BPH? |
|
Definition
- Static - prostate tissue OBSTRUCTs the bladder (epithelial), mediated by DHT
- Dynamic - increased tone/constriction of stromal tissue via adrenergic stimulation |
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Term
| What are Lower Urinary Tract Symptoms (LUTS)? |
|
Definition
- Storage - problems storing: urgency, frequency, incontinence
- Voiding - hesitancy, dribbling
- Post-micturition - sense of incomplete voiding, post-dribble
**pelvic pain not a symptom.
**Aging = incr in LUTS. LUTS caused by static component? |
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|
Term
| What are complications of BPH? |
|
Definition
- Acute Urinary Retention**
- Incontinence
- Renal problems |
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|
Term
| What is male hypogonadism? |
|
Definition
| Failure to produce physiological testosterone due to a disruption in the HPT axis -- androgen deficiency |
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|
Term
| What is the anatomy of hypogonadism? |
|
Definition
- Leydig cells respond to LH to produce testosterone
- Sertoli cells response to FSH to control spermatogenesis
- Negative feedback on the hypothalamus and anterior pituitary from testosterone.
- If testosterone is LOW, FSH/LH will be high to try to bring it back up |
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Term
| What is the difference between primary and secondary hypogonadism? |
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Definition
- Primary - a problem in the gonads. Elevated LH/FSH.
- Secondary - a problem in hypothalamus-anterior pituitary. LH/FSH are low.
**LH is main indicator |
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Term
| How is diagnosis of hypogonadism made? |
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Definition
| Consistently low serum testosterone measured in the morning, consistent s/s. |
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Term
| What are specific symptoms of hypogonadism? |
|
Definition
reduced libido
Gynecomastia
Loss of hair, shrinking testes
Infertility
Height loss, osteoporosis
Sweating, hot flashes |
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Term
| What are non-specific symptoms of hypogonadism? |
|
Definition
Decreased energy
Depression
Sleep disturbance
Anemia
Reduced muscle mass
Incr body fat |
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