AUA 2023 CAIS and Endopelvic Fascia Quiz

CAIS and Gonadal Risk

• Complete Androgen Insensitivity Syndrome (CAIS) patients typically have female-typical external genitalia.
• If testes are retained post-puberty, there's an increased risk of seminoma over time.
• Historically, gonads were removed at diagnosis, but low malignancy risk allows some patients to retain gonads for potential endocrine and reproductive benefits.
• A malignancy surveillance plan is critical for those choosing to keep gonads.
• Gonadoblastoma risk exists for dysgenetic gonads with Y chromosome material, but not in CAIS.
• CAIS individuals don't have a higher risk of Leydig cell tumors, embryonal carcinoma, or teratomas compared to the general population.

Endopelvic Fascia

• The endopelvic fascia originates from the transversalis fascia and is crucial for pelvic and retropubic urologic surgery.
• It encases pelvic viscera including the bladder, prostate, vagina, and rectum.
• Formed by intermediate stratum condensations, it creates ligaments such as pubourethral, puboprostatic, and pubocervical ligaments.
• The levator ani muscle, Denonvilliers' fascia, internal oblique fascia, and obturator internus muscle are not parts of the endopelvic fascia.

Non-Gonococcal Urethritis Treatment

• Non-gonococcal urethritis not responsive to doxycycline should be treated with azithromycin.
• Chlamydia trachomatis or Ureaplasma urealyticum infections cannot be clinically differentiated.
• Recommended treatment is doxycycline (100 mg twice daily for 14 days) or a single dose of azithromycin (1 gram).
• Resistance to doxycycline may indicate the presence of resistant Ureaplasma urealyticum.
• Other treatments include erythromycin and ofloxacin, while spectinomycin, ceftriaxone, amoxicillin-clavulanic acid, and penicillin are not recommended.

Detumescence of the Penis

• Detumescence of the penis occurs via norepinephrine release by sympathetic adrenergic nerves, maintaining tonic contraction of smooth muscle in penile vessels.
• Erection is mediated through parasympathetic stimulation, releasing nitric oxide which leads to cyclic GMP generation and relaxation of penile smooth muscle.
• Acetylcholine, vasoactive intestinal polypeptide, cyclic GMP, and prostaglandin do not play a role in detumescence.

This quiz covers key concepts related to Complete Androgen Insensitivity Syndrome (CAIS) as discussed in the AUA 2023 guidelines. Participants will explore the implications of gonadal management and the anatomy related to endopelvic fascia. Test your knowledge on this critical topic in urology.