Genitourinary Disease PDF

10/23/2024 Male genitourinary system Genitourinary Disease DENT 6655 Overview: Penile Lesions Congenital/neoplastic conditions of the penis...

10/23/2024 Male genitourinary system Genitourinary Disease DENT 6655 Overview: Penile Lesions Congenital/neoplastic conditions of the penis Malformations Congenital, inflammatory, vascular and Abnormal location of the distal urethral orifice neoplastic disorders of the testis  Hypospadias: opening along the ventral aspect Benign and malignant conditions of the prostate of the penis Neoplasms of the urinary bladder Can be constricted (resulting ↑ UT infections) Sexually transmitted diseases  Epispadias: less common, opening along the dorsal aspect of the penis UT obstruction urinary incontinence Penile Neoplasms Squamous cell carcinoma and its precursor lesions are the most common Account for 0.4% of all cancers in males in U.S. Uncircumcised men over age 40 Associated with HPV 16/18 infection Often preceded by premalignant lesion, red/white plaque 1  10/23/2024 Epithelial Dysplasia Severe dysplasia Normal Mild Severe Ca in-situ Bowen disease = carcinoma in-situ Penile Neoplasms Squamous Cell Carcinoma Squamous cell carcinoma Rare among men circumcised early in life Crusted plaque, nodule; ulceration and irregular margins Less commonly a papillary mass Distant metastases are relatively uncommon 66% 5 year survival (localized); 27% with metastases to inguinal lymph nodes Scrotum, Testis, and Epididymis Disorders of the Testes Scrotum Cryptorchidism - Incomplete descent of the testis from the abdomen to the scrotum Inflammatory processes/fungal infections/ dermatoses 1% of 1-year-old males Rare neoplasms; most squamous cell carcinoma May be unilateral or bilateral; may lead to sterility 1st human cancer associated with occupational (environmental) factors (chimney sweeps) 3-5 fold increased risk for testicular cancer intratubular germ cell neoplasia develops within the atrophic tubules Orchiopexy reduces risk of sterility and cancer 2  10/23/2024 Disorders of the Testes Disorders of the Testes Inflammatory lesions of the testis Vascular Disturbances More common in epididymis (epididymitis) than Torsion – twisting of the spermatic cord testis proper (orchitis)  obstruction of venous drainage resulting in Swelling and tenderness rapid, intense vascular engorgement Complication from urinary tract infections  adolescence; sudden onset testicular pain Often associated with STDs  urologic emergency Complication of mumps in adults (~20%)  infarction will occur if torsion not relieved http://www.meddean.luc.edu/ http://www.toddbuck.com/normal-tunica-vaginalis-bell-clapper-deformity-and-testicular/ Disorders of the Testes Testicular Neoplasms Testicular Neoplasms Germ Cell tumors 6/100,000 males Divided into 2 groups: peak incidence 15-34 years  seminomas vs. non-seminomatous tumors most common cause of painless testicular Increased frequency in undescended testis enlargement  3-5 fold increased risk Heterogenous group of tumors  Only 10% of patients have hx cryptorchidism  95% arise from germ cells; malignant Histologic appearance may be pure (single cell  5% arise from Sertoli or Leydig cells (sex cord-stromal type), often mixed (multiple cell types) tumors); generally benign 3  10/23/2024 Germ Cell Tumors Germ Cell Tumors Seminomas: Non-seminomatous tumors: Several types, tend to spread early via lymphatics arise from epithelium of the seminiferous tubules and blood vessels Indolent, often remain confined to the testis; may even small tumors may present with extensive eventually spread via lymphatics metastases (liver, lung) respond well to chemotherapy; radiosensitive tumor markers: α-fetoprotein (AFP) and human  one of most curable cancers chorionic gonadotropin (HCG) Seminoma Embryonal Carcinoma (non-seminomatous) Germ Cell Tumors Prostate Prognosis: 8,000 new cases in US annually, < 400 die of disease 95% early-stage seminomas are cured 90% pts with nonseminomatous tumors achieve remission with chemotherapy, most are cured Exception: pure choriocarcinoma (2 years duration) Hutchinson’s Triad: 1. Hutchinson’s Teeth (notched incisors/mulberry molars) 2. Interstitial keratitis (corneal) 3. Eighth cranial nerve deafness 9  10/23/2024 Syphilis Diagnosis: ID of bacteria within primary or secondary lesions Screening tests: RPR (rapid plasma reagin) and VDRL (Venereal Disease Research Laboratory)  Often negative in early stages of disease  ~15% false-positive tests Specific tests: FTA (Fluorescent Treponemal Antibody)  Positive later in disease course  Remain positive indefinitely, even after treatment Treatment: antibiotics (penicillin) Syphilis: dark-field microscopy 10