PATHOPHYSIOLOGY EXAM 3-STUDY GUIDE
Genitourinary / Reproductive & STIs
Diagnostic Evaluation of Bladder Structure & Function
Physical Examination
• Postvoid residual (PVR) assesses bladder emptying
o Measures urine left after voiding
o Methods: palpation, percussion, catheterization, ultrasonography
o Normal: < 50 mL (adequate emptying)
o > 200 mL: indicates urinary retention/inadequate emptying
• Pelvic exam (females)
o Evaluates perineal skin integrity
o Assesses vaginal muscle tone, atrophy, prolapse, pelvic masses
o Identifies conditions affecting bladder function
• Bimanual exam
o Can assist in estimating bladder size/PVR
• Rectal exam
o Assesses perineal sensation, sphincter tone, fecal impaction, rectal masses
o In males, evaluates prostate contour
Laboratory & Radiologic Studies
• Urinalysis, BUN, creatinine
o Assess renal function and urinary tract infection
• Bladder ultrasonography (bladder scan)
o Noninvasive estimation of bladder volume/PVR
o Helps guide need for catheterization or bladder training
• Cystoscopy
o Direct visualization of the bladder for diagnostic evaluation
• Excretory urography (IV pyelogram)
o Uses IV contrast and imaging to evaluate urinary tract anatomy
Urodynamic Studies (Bladder Function Testing)- Evaluate bladder, urethral, and pelvic floor
function, including pressures and urine flow
• Uroflowmetry
o Measures urine flow rate and voiding speed
• Cystometry
o Measures bladder pressure during filling and emptying
o Evaluates:
▪ Bladder capacity
▪ Sensation of fullness
▪ Ability to contract and inhibit urination
▪ Presence of involuntary contractions
• Urethral pressure profile
o Measures pressure along urethra at rest
o Assesses urethral smooth muscle function
• Sphincter electromyography
, o Evaluates activity of pelvic floor and external sphincter muscles
o Uses surface, catheter, anal plug, or needle electrodes
Bladder Cancer
Overview
• Most common urinary tract cancer in the U.S.
• Typically occurs in males > 55 years
• Most cases are urothelial (transitional cell) carcinoma
• Two types:
o Low-grade, noninvasive tumors
o High-grade invasive tumors (higher metastasis risk, worse prognosis)
Etiology & Risk Factors
• Cause is unclear but linked to chronic exposure to urinary carcinogens
• Risk factors:
o Cigarette smoking (major risk factor; ~30–50% of cases)
o Arsenic exposure in drinking water
o Chronic bladder infections or bladder stones
Clinical Manifestations
• Painless hematuria (most common sign)
o May be gross or microscopic
o Often intermittent
• Possible urinary symptoms:
o Frequency
o Urgency
o Dysuria
• Advanced disease:
o Ureteral obstruction
o Renal damage
o Metastasis
• High-risk patients may undergo periodic urine cytology
• Prognosis depends on tumor grade and stage at diagnosis
Diagnosis
• Urine cytology
• Cystoscopy with biopsy (gold standard)
• Excretory urography
• Imaging for staging:
o CT scan
o MRI
o Ultrasound
Treatment
• Based on tumor grade, invasion, and patient health
• Options include:
o Endoscopic resection (diagnosis + treatment for superficial tumors)
o Diathermy (tumor destruction)
o Segmental surgical resection (for localized tumors)
o Intravesical chemotherapy or immunotherapy
, ▪ Delivered directly into bladder to reduce systemic side effects
Male Reproductive System
Hormonal Control of Male Reproductive Function
Androgens & Testicular Hormones
• Testes produce androgens:
o Testosterone (primary hormone)
o Dihydrotestosterone (DHT)
o Androstenedione
• Also produce small amounts of estradiol and estrone
• Leydig cells
o Stimulated by LH
o Produce ~6 mg/day testosterone
Testosterone Overview
• Most abundant androgen; main testicular hormone
• Essential for spermatogenesis and male sexual development
• Circulates in:
o Free (active) form
o Protein-bound form
• Metabolism:
o Liver metabolizes
o Kidneys excrete
• Tissue conversion:
o Converted to estradiol (aromatization)
o Converted to DHT (more potent androgen)
Testosterone Effects
• Fetal development:
o Male internal/external genital formation
o Testicular descent
• Sexual development:
o Primary and secondary sex characteristics
o Pubic, facial, chest hair growth
o Deepening voice (laryngeal changes)
• Skin:
o Increased sebaceous activity → acne risk
• Reproductive:
o Supports spermatogenesis and sperm maturation
• Systemic effects:
o Stimulates erythropoiesis
o Promotes protein synthesis, muscle growth, fat distribution
Endocrine Regulation (HPG Axis)
• Hypothalamus: releases GnRH
• Anterior pituitary: releases LH and FSH
• LH
• Stimulates Leydig cells → testosterone production
, • Negative feedback: high testosterone suppresses GnRH and LH
• FSH
• Acts on Sertoli cells → initiates spermatogenesis
• Sertoli cells produce:
o Androgen-binding protein (ABP): concentrates testosterone in testes
o Inhibin: suppresses FSH (negative feedback loop)
o Plasminogen activator: supports sperm release/maturation
Disorders of Scrotum & Testes
Cryptorchidism (Undescended Testes)
• Failure of one or both testes to descend into scrotum
• Most common congenital male GU disorder
• More common in preterm infants
• Types:
o Primary: failure of normal descent
o Secondary: previously descended testis retracted upward (e.g., post-surgical
scarring)
• Risks:
o Infertility
o Increased cancer risk
o Testicular torsion
• Presentation:
o Absent or non-palpable testis in scrotum
• Diagnosis: physical exam
• Treatment:
o Surgical correction (orchiopexy) preferred
o Hormonal therapy no longer recommended
Testicular Torsion
• Twisting of spermatic cord → loss of blood flow
• True urologic emergency
• Testicular viability declines after ~6 hours
Intravaginal Torsion (most common)
• Occurs in adolescents/young adults
• Often related to abnormal attachment + cremasteric contraction
• Symptoms:
o Sudden severe unilateral scrotal pain
o Nausea/vomiting
o Swollen, tender testis
• Requires immediate surgery
Extravaginal Torsion
• Occurs in neonates
• Poor fixation of testicle to scrotal wall
• Findings:
o Firm, painless scrotal mass
o High-riding testis
o Often absent cremasteric reflex
Genitourinary / Reproductive & STIs
Diagnostic Evaluation of Bladder Structure & Function
Physical Examination
• Postvoid residual (PVR) assesses bladder emptying
o Measures urine left after voiding
o Methods: palpation, percussion, catheterization, ultrasonography
o Normal: < 50 mL (adequate emptying)
o > 200 mL: indicates urinary retention/inadequate emptying
• Pelvic exam (females)
o Evaluates perineal skin integrity
o Assesses vaginal muscle tone, atrophy, prolapse, pelvic masses
o Identifies conditions affecting bladder function
• Bimanual exam
o Can assist in estimating bladder size/PVR
• Rectal exam
o Assesses perineal sensation, sphincter tone, fecal impaction, rectal masses
o In males, evaluates prostate contour
Laboratory & Radiologic Studies
• Urinalysis, BUN, creatinine
o Assess renal function and urinary tract infection
• Bladder ultrasonography (bladder scan)
o Noninvasive estimation of bladder volume/PVR
o Helps guide need for catheterization or bladder training
• Cystoscopy
o Direct visualization of the bladder for diagnostic evaluation
• Excretory urography (IV pyelogram)
o Uses IV contrast and imaging to evaluate urinary tract anatomy
Urodynamic Studies (Bladder Function Testing)- Evaluate bladder, urethral, and pelvic floor
function, including pressures and urine flow
• Uroflowmetry
o Measures urine flow rate and voiding speed
• Cystometry
o Measures bladder pressure during filling and emptying
o Evaluates:
▪ Bladder capacity
▪ Sensation of fullness
▪ Ability to contract and inhibit urination
▪ Presence of involuntary contractions
• Urethral pressure profile
o Measures pressure along urethra at rest
o Assesses urethral smooth muscle function
• Sphincter electromyography
, o Evaluates activity of pelvic floor and external sphincter muscles
o Uses surface, catheter, anal plug, or needle electrodes
Bladder Cancer
Overview
• Most common urinary tract cancer in the U.S.
• Typically occurs in males > 55 years
• Most cases are urothelial (transitional cell) carcinoma
• Two types:
o Low-grade, noninvasive tumors
o High-grade invasive tumors (higher metastasis risk, worse prognosis)
Etiology & Risk Factors
• Cause is unclear but linked to chronic exposure to urinary carcinogens
• Risk factors:
o Cigarette smoking (major risk factor; ~30–50% of cases)
o Arsenic exposure in drinking water
o Chronic bladder infections or bladder stones
Clinical Manifestations
• Painless hematuria (most common sign)
o May be gross or microscopic
o Often intermittent
• Possible urinary symptoms:
o Frequency
o Urgency
o Dysuria
• Advanced disease:
o Ureteral obstruction
o Renal damage
o Metastasis
• High-risk patients may undergo periodic urine cytology
• Prognosis depends on tumor grade and stage at diagnosis
Diagnosis
• Urine cytology
• Cystoscopy with biopsy (gold standard)
• Excretory urography
• Imaging for staging:
o CT scan
o MRI
o Ultrasound
Treatment
• Based on tumor grade, invasion, and patient health
• Options include:
o Endoscopic resection (diagnosis + treatment for superficial tumors)
o Diathermy (tumor destruction)
o Segmental surgical resection (for localized tumors)
o Intravesical chemotherapy or immunotherapy
, ▪ Delivered directly into bladder to reduce systemic side effects
Male Reproductive System
Hormonal Control of Male Reproductive Function
Androgens & Testicular Hormones
• Testes produce androgens:
o Testosterone (primary hormone)
o Dihydrotestosterone (DHT)
o Androstenedione
• Also produce small amounts of estradiol and estrone
• Leydig cells
o Stimulated by LH
o Produce ~6 mg/day testosterone
Testosterone Overview
• Most abundant androgen; main testicular hormone
• Essential for spermatogenesis and male sexual development
• Circulates in:
o Free (active) form
o Protein-bound form
• Metabolism:
o Liver metabolizes
o Kidneys excrete
• Tissue conversion:
o Converted to estradiol (aromatization)
o Converted to DHT (more potent androgen)
Testosterone Effects
• Fetal development:
o Male internal/external genital formation
o Testicular descent
• Sexual development:
o Primary and secondary sex characteristics
o Pubic, facial, chest hair growth
o Deepening voice (laryngeal changes)
• Skin:
o Increased sebaceous activity → acne risk
• Reproductive:
o Supports spermatogenesis and sperm maturation
• Systemic effects:
o Stimulates erythropoiesis
o Promotes protein synthesis, muscle growth, fat distribution
Endocrine Regulation (HPG Axis)
• Hypothalamus: releases GnRH
• Anterior pituitary: releases LH and FSH
• LH
• Stimulates Leydig cells → testosterone production
, • Negative feedback: high testosterone suppresses GnRH and LH
• FSH
• Acts on Sertoli cells → initiates spermatogenesis
• Sertoli cells produce:
o Androgen-binding protein (ABP): concentrates testosterone in testes
o Inhibin: suppresses FSH (negative feedback loop)
o Plasminogen activator: supports sperm release/maturation
Disorders of Scrotum & Testes
Cryptorchidism (Undescended Testes)
• Failure of one or both testes to descend into scrotum
• Most common congenital male GU disorder
• More common in preterm infants
• Types:
o Primary: failure of normal descent
o Secondary: previously descended testis retracted upward (e.g., post-surgical
scarring)
• Risks:
o Infertility
o Increased cancer risk
o Testicular torsion
• Presentation:
o Absent or non-palpable testis in scrotum
• Diagnosis: physical exam
• Treatment:
o Surgical correction (orchiopexy) preferred
o Hormonal therapy no longer recommended
Testicular Torsion
• Twisting of spermatic cord → loss of blood flow
• True urologic emergency
• Testicular viability declines after ~6 hours
Intravaginal Torsion (most common)
• Occurs in adolescents/young adults
• Often related to abnormal attachment + cremasteric contraction
• Symptoms:
o Sudden severe unilateral scrotal pain
o Nausea/vomiting
o Swollen, tender testis
• Requires immediate surgery
Extravaginal Torsion
• Occurs in neonates
• Poor fixation of testicle to scrotal wall
• Findings:
o Firm, painless scrotal mass
o High-riding testis
o Often absent cremasteric reflex
