GU

• Cryptorchidism (undescended testes):

  • One or both testicles fail to move down into the scrotal sac
  • Testes develop intra-abdominal in the fetus
  • Usually descends into scrotum through the inguinal canal 7-9 months of gestation
  • Undescended testes may remain in lower abdomen or at a point of descent in the inguinal canal
  • Consequences include infertility, malignancy, testicular torsion (10x risk), and possible psychological effects
• Hydrocele:

  • Fluid accumulation in layers around scrotum
• Hematocele:

  • Blood in layers around scrotum
• Spermatocele:

  • Cyst in epididymis that might contain sperm
• Varicocele:

  • Enlargement of veins of scrotum
• Testicular Torsion:

  • Reduces blood flow causing pain and swelling
• Orchitis:

  • Infection of testes, often from epididymitis
  • Can be caused by the mumps virus
  • Sudden onset characterized by painful enlargement of testes
  • Atrophy of testes may occur impacting spermatogenesis
  • Permanent sterility is rare
• Testicular cancer:

  • Most common in 15-29 yr old range, 5yr survival rate 97%
  • Surgical removal of testes and spermatic cord plus radiation
  • Risk factors include cryptorchidism, family history, personal history
  • TNM classification for testicular cancer:
  • Stage 1: tumor confined to testes, epididymis, or spermatic cord
  • Stage 2: tumor spreads to retroperitoneal lymph nodes below diaphragm
  • Stage 3: metastases outside retroperitoneal nodes or above diaphragm
• Prostatitis:

  • Acute bacterial prostatitis commonly caused by ascending urethral infection (E.coli)
  • Symptoms include fever, malaise, frequent/urgent urination, and urethral discharge
  • Treatment involves antibiotics, reduced activity, hydration, and pain management
• Benign Prostatic Hyperplasia (BPH):

  • Age-related non-malignant enlargement of prostate gland
  • Static symptoms include weak urinary stream, postvoid dribbling, frequency of urination, and nocturia
  • Dynamic symptoms related to prostatic smooth muscle tone
  • Treatment options include A1-adrenergic blocking drugs, 5-a reductase inhibitors, and surgery
• Prostate Cancer:

  • Risk factors include age, diet, ethnicity, genetic factors, and lifestyle
  • Screening methods include digital rectal exam and PSA
  • Treatment options include watchful waiting, surgery, radiation therapy, chemotherapy, hormonal therapy, and combination therapies
• Cervical Cancer:

  • Associated with HPV infection
  • Risk factors include early age at first intercourse, multiple sexual partners, smoking, and history of STIs
  • HPV types 16, 18, 31, 33, 45 increase the risk of cervical cancer
  • Gardisil or Cervarix vaccine can prevent infection with HPV subtypes 16, 18, 6, 11
• Prostate tumour Grading System:

  • T1: Primary-stage tumours are asymptomatic and discovered on histologic examination of prostatic tissue specimens
  • T2: Tumours are palpable on digital examination but confined to prostate gland
  • T3: Tumours extended beyond prostate
  • T4: Tumours have pushed beyond the prostate to involve adjacent structures
• Gynecologic cancers overview:

  • Vulva: Squamous cell carcinomas
  • Vaginal
  • Cervix: Squamous cell carcinomas
  • Endometrium: Associated with conditions producing excessive estrogen stimulation and endometrial hyperplasia
  • Ovaries: Most common and most lethal cancer
• Stages of gynecologic cancer:

  • Stage 0: Rarely used; preinvasive lesions
  • Stage I: Cancer confined to organ it originated in
  • Stage 2: Cancer involves some structures surrounding the organ of origination
  • Stage 3: Regional spread of cancer with lymph node involvement
  • Stage 4: Distant spread of cancer with metastasis
• Composition of Cervix:

  • Undergoes functional changes during each menstrual cycle related to spermatozoa transport
  • Exocervix covered with stratified squamous epithelium, which also lines vagina
  • Endocervical canal lined with columnar epithelium
  • Transformation zone is the area vulnerable to dysplasia & susceptible to cancerous transformation
  • Transformation zone is the area of cervix focused on in a pap smear test
• Cervical Intraepithelial Neoplasia (CIN) Grading System:

  • CIN I (mild dysplasia): Initial ⅓ of epithelial layer involved
  • CIN II (moderate dysplasia): Initial ⅔ of epithelial layer
  • CIN III (severe dysplasia/carcinoma in situ): Full thickness involvement
• Screening & Diagnosis of Cervical Cancer:

  • Pap smear demonstrates SIL (squamous intraepithelial lesion)
  • Colposcopy for visualization of the cervix if pap is abnormal
  • Biopsy sample
  • Cervicography for images submitted for diagnosis to an MD
  • LEEP or LLETZ for treatment
• Treatment of Cervical Cancer:

  • Removal of lesion by various techniques
  • Therapeutic conization if lesion extends into endocervical canal
  • Radiation and surgery if it has invaded
  • Radical hysterectomy if severe
  • LEEP and LLETZ can also be part of treatment
• Cervical Cancer & STI:

  • Casual link between human papilloma viruses (HPV) infection and cervical cancer
  • Gardisil or Cervarix vaccine prevents infection with HPV subtypes 16, 18, 6, 11
• Disorders of The Uterus:

  • Endometritis: Cervical barrier is compromised
  • Endometriosis: Functional endometrial tissue is found in ectopic sites
  • Endometrial Cancer: Most common cancer found in the female pelvis
• Pelvic Inflammatory Disease (PID):

  • Inflammation of upper reproductive tract involving uterus, fallopian tubes, ovaries
  • Polymicrobial infection
  • Complications include peritonitis, pelvic abscesses, ectopic pregnancy
• Ovarian Cysts and Tumours:

  • Cysts are the most common form of ovarian tumor
  • Polycystic Ovary Syndrome (PCOS) is a common source of chronic anovulation
  • Ovarian Tumours may be hormonally active
• Breast Cancer:

  • Most common female cancer
  • 2nd leading cause of cancer-related deaths in women
  • Risk factors include sex, age, hormone influence, obesity, alcohol, physical inactivity
• Examination for Breast Cancer:

  • Screening mammography every 2 years between 50-74 years old
  • Self-examination no longer recommended
• Screening mammography is recommended every 2 years for women between 50-74 years old
• Self-examination for breast cancer is no longer recommended
• Known mutations related to breast cancer:

  • BRCA1 on chromosome 17, a tumor suppressor gene
  • BRCA2 on chromosome 13
• Diagnosis of breast cancer can include:

  • Physical exam
  • Mammography
  • Ultrasonography
  • Percutaneous needle aspiration
  • Stereotactic needle biopsy
  • Excisional biopsy
• STIs have a broad range of infectious diseases spread by sexual contact

  • Often asymptomatic
  • Condoms can prevent spread
  • Agents of transmission include bacteria, viruses (HIV, HSV, HPV), fungi, protozoa, parasites, and unidentified microorganisms
  • Portals of entry: mouth, genitalia, urinary meatus, rectum, skin
• High-risk strains of HPV can lead to:

  • Genital warts (HPV 6 + 11)
  • Cervical dysplasia (HPV 16 and 18)
  • Cervical cancer (HPV 16 and 18)
• Herpes viruses include:

  • Herpes Simplex Virus type 1 (cold sores)
  • Herpes Simplex Virus type 2 (genital herpes)
  • Varicella-zoster virus (chicken pox, shingles)
• Diagnosis and pathogenesis of genital herpes infections:

  • Replicates in skin and mucous membranes
  • Grows in neurons and shares biologic property of latency
  • Diagnosis based on symptoms, appearance of lesions, and identification of virus from cultures
• Candidiasis is not an STI caused by Candida, a yeast-like fungi

  • Commonly identified species is Candida albicans
  • Can cause balanitis in men
  • Causes include antibiotic therapy, high hormone levels, diabetes mellitus, or HIV infection
• Gonorrhea is caused by a pyogenic, gram-negative diplococcus

  • Primarily infects warm, mucus-secreting epithelia
  • Transmission through intercourse
  • Can infect newborns during birth
• Chlamydia is the most prevalent STI in Canada

  • Caused by Chlamydia trachomatis, an atypical, gram-negative bacteria
  • Transmission through vaginal, anal, or oral sex
  • Symptoms include mucopurulent vaginal discharge, pelvic pain, urethritis, and testicular pain
• Syphilis is caused by the bacterial spirochete Treponema pallidum

  • Can spread to fetus in utero
  • Primary, secondary, and tertiary stages with various symptoms
  • Treatment with penicillin
• HIV and AIDS:

  • HIV leads to immunodeficiency by attacking CD4 T lymphocytes
  • Diagnosis through blood tests for antibodies to the virus
  • Treatment with anti-retroviral therapy (ART) to reduce viral levels in the body
• Diagnosis of AIDS:

  • Defined by CDC criteria including low CD4+ T cell count and specific illnesses
  • CD4+ T cells are white blood cells important for the immune system
  • Opportunistic infections and cancers are common
• Preventative measures for HIV include:

  • PrEP (pre-exposure prophylaxis) for HIV-negative individuals
  • PEP (post-exposure prophylaxis) within 72 hours after exposure
  • ART for HIV-positive individuals to reduce viral levels