Mario is a 68-year-old male whose wife died of cancer 5 years ...

[nautica902]

Mario is a 68-year-old male whose wife died of cancer 5 years ago. Since her death, he began to eat more fast food and stay at home and watch television. Recently, however, Mario's friend introduced him to a woman whom he became to like very much.
 
  After seeing her a few times, Mario became concerned about his health and went to see his doctor. He noticed a change in his sexual performance when he turned 60 and, after seeing so much on television about erectile dysfunction, was concerned he would experience this with his girlfriend.
 
  What factors are present in Mario's history that predispose him to erectile dysfunction?
 
  What condition would you suspect if Mario had a blood test indicating elevated LH and decreased testosterone levels? What effect do low testosterone levels have on the reproductive organs of the male?
 
  How do the parasympathetic and sympathetic nervous systems generate erection, emission, and ejaculation?

Question 2

Darius is 63 years old and began to awake at night to urinate. When he went to the bathroom, he had to strain to initiate the flow, and the stream of urine was weak.
 
  Over time, the pattern became more apparent during the day; he often had a sense of urgency and felt he was going to the bathroom frequently. When he did, however, he did not always feel he had emptied his bladder, and he tended to dribble throughout the day. Much to his reluctance, his wife urged him to see a physician. At the doctor's office, his case history was carefully taken, a digital rectal exam was performed, and lab work was ordered. His blood results were unremarkable, but his urinalysis showed an elevated white blood cell count and bacteria. His physician diagnosed Darius with benign prostatic hyperplasia and urinary tract infection.
 
  How does BPH contribute to the signs and symptoms of bladder dysfunction, and how was Darius prone to developing a urinary tract infection?
 
  What are the static and dynamic components of BPH? Why are 1-adrenergic receptor blockers sometimes used to treat prostatic hyperplasia?
 
  How would the prostate feel during a digital rectal exam with benign prostatic hyperplasia, acute bacterial prostatitis, and prostate cancer?
 
  Why does the patient with prostate cancer present with symptoms later in the disease?

[emsimon14]

Answer to Question 1

Mario's age is a major etiological factor for erectile dysfunction. It would also appear in his history that he has a lowered self-esteem; he had taken less care of himself since his wife died and was concerned about his sexual performance with his new girlfriend. Poor dietary choices and increased time spent in front of the television are further predisposing factors for ED.

Mario would likely be presenting with primary hypogonadism (hypergonadotropic hypogonadism). When testosterone levels decline, the testes become smaller and softer. The prostate enlarges and prostatic contractions weaken. While the seminiferous tubules thicken, the seminal vesicles become thin and less contractile as muscle is replaced by connective tissue. In the penis, there are fibrotic changes in the erectile tissues and vascular sclerosis. Because seminal fluid production also declines, the force of ejaculation is weakened.

The parasympathetic nervous system is responsible for erection. Parasympathetic activity inhibits the sympathetic nervous system's effect on promoting detumescence. It also encourages nitric oxide release to relax the smooth muscle of the sinusoidal spaces in the corpus cavernosum, enabling erection to occur.
Sympathetic activity is responsible for emission and ejaculation. Emission involves the process of sperm moving from the epididymis to the urethra and requires smooth muscle contraction in the vas deferens and ampulla. Sympathetic impulses also ensure muscular contractions of the seminal vesicles and prostate gland to propel seminal fluid along the urethra. The ischiocavernous and bulbocavernous muscles, under sympathetic influence, aid in the final propulsion of seminal fluid out of the penis.

Answer to Question 2

Because the prostate encircles the urethra, benign prostatic hyperplasia occludes urinary outflow from the bladder. Residual urine remaining in the bladder contributes to feelings of frequency, urgency, and nocturia. Overflow incontinence occurs if the bladder becomes particularly distended. Darius developed a urinary tract infection as a result of his inability to completely empty his bladder and subsequent urinary retention.

The static component of BPH involves the increase in physical size of the prostate due to hyperplastic change. The dynamic component involves an alteration in tone of the prostatic smooth muscle. The use of 1-receptor blockers for the treatment of BPH functions to block neural transmission to smooth muscle and inhibit contraction.

The prostate exhibiting benign hyperplasia would feel enlarged, smooth, and rubbery. The cancerous prostate would feel fixed with hard, nodular areas. A rectal exam for acute bacterial prostatitis would reveal a warm, swollen, tender prostate with scattered softened areas.

In benign prostatic hyperplasia, the prostate is enlarged throughout the gland with discrete periurethral lesions. Because the urethra is compressed early in the disease, signs and symptoms appear quickly. With prostate cancer, the peripheral regions (particularly the posterior aspect) of the gland are affected. The urethra remains open and unaffected until the cancer has progressed. Bladder symptoms therefore arise later in the course of the disease.