Lecture 29 Male Reproductive System 2023 McGriff.pdf

Male Reproductive Disorders WIL MCGRIFF, MPH, OD CHRISTOPHER WALKEN, OD, FAAO ASSOCIATE PROFESSOR MORE COWBELL [email protected] [email protected] Lecture Learning Objectives u Differentiate between types of common prostate disorders u Understand the ocular health issues related to erectile...

Male Reproductive Disorders WIL MCGRIFF, MPH, OD CHRISTOPHER WALKEN, OD, FAAO ASSOCIATE PROFESSOR MORE COWBELL [email protected] [email protected] Lecture Learning Objectives u Differentiate between types of common prostate disorders u Understand the ocular health issues related to erectile dysfunction NBEO Outline L. Reproductive System (NBEO 36 R 1-6) 1. Epidemiology 5. Diagnostic testing and imaging 6. Diseases/Disorders c. Disorders of the prostate d. Erectile dysfunction Male Reproductive System u u u External u Testes u Penis Internal u Seminal vesicles u Prostate gland u Bulbourethral glands Regulation via u FSH and LH u Autonomic nervous system Benign Prostatic Hyperplasia (BPH) u u u 80% of men > 60 years Clinical manifestations u Urinary retention u Obstruction to flow u Decreased stream u Hesitancy u Infection due to retention Etiology unknown u u Hormonal association Treatment u Medication u Surgery Floppy Iris Syndrome u Alpha-blockers promote blood flow to prostate u u Flomax, etc. Intra-operative complications u Poor dilation during surgery u Sudden constriction during surgery u “Floppy” iris u Increased risk for iris tear Prolapsed iris Pupil stabilized by iris retractors Prostatitis u ~2 million cases/yr u Inflammation of the prostate u 8 u Risk factors u Urethritis u Acute bacterial u Previous episode u Chronic bacterial u Pelvic trauma u Chronic prostatitis* u Unprotected sexual activity u Young adult to middle aged Normal protective barriers u Urethral length u Similar symptoms to BPH u Urination u Treatment u Ejaculation u Antibiotics u NSAIDS u Alpha-blockers BPH vs. Prostatitis? BPH uUrinary uOlder Issues Men Prostatitis uPain uYounger Men Prostate Cancer u u u Most prevalent non-cutaneous cancer in men u ~220,000 new cases annually/ ~35,000 deaths per year u 95% are adenocarcinomas Signs and symptoms u Asymptomatic until advanced stages u Symptoms are similar to BPH Risk factors u Age (>50 yoa) u Race (AA>CA&HA) u Dietary factors u Hormones u Familial factors 10 Prostate Cancer u u u Diagnosis u Digital rectal exam u Serum PSA* u Transrectal ultrasonography u Transrectal biopsy Treatment u Watchful waiting u Surgery u 93% 15-year survival rate Ocular metastases are possible u Bone, lymph node, lung, liver, & brain metastases more likely Prostate Specific Antigen (PSA) u Normal protein made by the prostate u u u Normal value <4ng/mL May increase with prostate cancer u Also increases w/ other causes u Some prostate cancers do not elevate PSA levels Not recommended as a sole diagnostic test u Should be accompanied with digital prostate exam Testicular Cancer u ~8,430 cases in 2015 / ~350 deaths u u u 95.3% survival at 5 years Rule of “90s” u 90% are germ cell tumors u 90% occur b/n 25 and 45 yoa u 90% of tumors are malignant u 90% are curable Self exams are key to diagnosis u Until age 45 u Risk factors u Undescended teste u Previous testicular cx u Family hx Erectile Dysfunction u Affects 20-30 million men u Erection u u Parasympathetic signal u Nitric oxide release Risk factors u Age u Vascular disease u u (Atherosclerosis, HTN, Diabetes, etc.) u Medications u Endocrine problems Treatment u Counseling u Surgery u Medication (PDE Inhibitors) Phosphodiesterase Type-5 Inhibitors u u PDE inhibitors prevent degradation of cGMP u Nitric oxide causes intracellular increase of cGMP u cGMP causes smooth muscle relaxation and vasodilation Adverse effects u Headache u Facial flushing u Blue vision u Dyspepsia u Nasal congestion u Concern if also taking nitroglycerin Non-Arteritic Ischemic Optic Neuropathy u Permanent vision loss due to decreased blood flow u u May be associated with PDE-5 inhibitors Confounders u Atherosclerosis u HTN u Hyperlipidemia u Diabetes u >50 yoa u Smoking u Small C/D Lecture Learning Objectives u Differentiate between types of common prostate disorders u Understand the ocular health issues related to erectile dysfunction Male Reproductive Disorders WIL MCGRIFF, MPH, OD CHRISTOPHER WALKEN, OD, FAAO ASSOCIATE PROFESSOR MORE COWBELL [email protected] [email protected]