#12. Diseases of Male Genital Organs - Phimosis, Paraphimosis, Peyronie's Disease, Priapism, Penile Cancer, Testicular Tumours

Question 1

What are the Options for Conservative Treatment of Primary Phimosis?

Answer 1

{Phimosis = Foreskin cannot be pulled back behind the Glans Penis}

• Corticosteroid Based Creams = BETAMETHASONE 0.05% Cream for 4 - 6 Weeks

Question 2

What are the Most Common Causes of Secondary Phimosis?

Answer 2

1) Lichen Sclerosus = Idiopathic Fibrosing disease of the Foreskin - can spread to Glans Penis / Distal Urethra

2) Recurrent Balanitis

3) Acquired via Forcible Retraction of Foreskin in Primary (Physiological) Phimosis

4) After Incomplete / Inadequate Circumcision

Question 3

What is Phimosis a Risk Factor of?

Answer 3

• Acute Complication of Phimosis is Paraphimosis

Question 4

Is Paraphimosis an emergency?

Answer 4

• YES it’s an emergency

Paraphimosis = Emergency condition that occurs in UNCIRUMCISED Men where NARROWED Foreskin is pulled behind the GLANS PENIS, where it BECOMES TRAPPED and CANNOT RETURN to its normal position.

Question 5

What are the Conservative Methods for Treating Paraphimosis?

Answer 5

1) Head / Foreskin are cleaned with Antiseptic Solution

2) Smeared with Sterile Petroleum Jelly

3) Penis is grasped with hand BEHIND Coronal Sulcus and Skin is PULLED FORWARD

4) Thumb of SAME Hand / Index Finger of OTHER Hand PRESS the Head to PASS THRU the ANNULUS FIBROSIS

Question 6

What is the Pathophysiology of Peyronie’s Disease?

Answer 6

Peyronie’s Disease = Dense Fibrosis BTW Tunica Albuginea AND Erectile Tissue of Corpora Cavernosa Penis

1) Inflammation of Blood Vessels of Connective Tissue BTW Cavernous Bodies AND Sheath

2) Intima of Blood Vessels is OEDEMATOUS / Thrombosis is observed

3) Thick CT Formation / Cartilaginous + Bony Tissue Deposition in Thickened Tissue

Question 7

What is the Difference Between Ischemic and Non-Ischemic Priapism?

Answer 7

Ischaemic = Veno-Occlusive

Non-Ischaemic = Arterial

Question 8

What are the Etiological Factors for Ischemic and Non Ischemic Priapism?

Answer 8

1) Ischaemic Priapism
- Hematological = Sickle Cell Anaemia / Leukemia / Lymphomas

• Neurological = CNS Injuries / Spinal Canal Stenosis + Damage
• Oncological = Carcinoma, Metastasis of Penis / Pelvic Carcinomas
• Meds = Antipsychotics / Anticoagulants / alpha-adrenergic

2) Non-Ischemic Priapism
- Injuries to Penis + Perineum

Question 9

What is the Treatment for Ischemic Priapism?

Answer 9

URGENT Treatment

• Aspiration of Blood FROM Cavernous Bodies
• Lavage with alpha-adrenergic Agonists
• OTHERWISE Distal Shunts BTW Corpora Cavernosa + Intact Corpus Spongiosum

Question 10

What are the Risk Factors for Penile Cancer?

Answer 10

• Phimosis = 11 - 16x
• Chronic Penile Inflammation
• HPV Infection
• Smoking = 5x
• Multiple Sexual Partners / 1st Intercourse at Young Age = 5x

Question 11

What are the Pathway Penile Cancer Spreads?

Answer 11

• Metastasis in Regional Lymph Nodes

Question 12

When is Inguinal Lymph Node Dissection indicated for Penile Carcinoma?

Answer 12

• In the Case of PALPABLE Inguinal Lymph Nodes in Lymph Node Metastasis
• HIGHER Stage than T1G2 (Invasive Carcinomas)

Question 13

What are the Risk Factors for Testicular Cancer?

Answer 13

• Cryptorchidism = 3 -6x
• Previous Tumour of Contralateral Testis = 12x of Metachronous Testicular Tumour
• HIV Infection
• Heredity = 4x
• HIGH Oestrogen Levels during Pregnancy

Question 14

What age group is most commonly affected by Testicular Cancer?

Answer 14

Most Common SOLID Tumour in Ages 20 - 45

Question 15

What is the Clinical Picture of Testicular Cancer?

Answer 15

• Enlargement of the Testicle / Thickening of it
• PAINLESS
• Pain IF there’s Haemorrhage in the Tumour

Question 16

What are the Pathways Testicular Cancer Spreads?

Answer 16

1) Lymphovascular = Retroperitoneal Lymph Nodes (Para-Aortic / Para-Caval)

2) Hematogenous = Lung / Liver / Brain

Question 17

What is the Clinical Significance of Testicular Tumour Markers?

Answer 17

• Serum Tumour markers have NO Value in Initial Diagnosis BUT have a PROGNOSTIC Value
• Oncofoetal Markers = AFP / Beta-Chorionic Gonadotropin
• Cellular Enzymes = LDH

Question 18

In a Patient with Elevated Alpha-Fetoprotein Level, what is the expected histological type of the tumour - Seminoma or Non-Seminoma?

Answer 18

• If there’s ELEVATED Levels of AFP, it is a NON-SEMINOMA Germ Cell Tumour
• Whereas for Beta-Chorionic Gonadotropin = In Non-Seminoma / 30% Seminoma

Question 19

Where are the Extragonadal Germ Cell Tumours most commonly located?

Answer 19

• From the EMBRYONIC PLURIPOTENT Cells
• In the MIDLINE of the Body

Question 20

Which Group of Tumours is Radiosensitive - Seminoma or Non-Seminoma?

Answer 20

• SEMINOMAS are Radiosensitive

Question 21

Which Group of Germ Cell Tumours - Seminoma or Non-Seminoma, may require Retroperitoneal Lymph Node Dissection?

Answer 21

NON-SEMINOMA Germ Cell Tumours require RETROPERITONEAL LN DISSECTION

• For Retroperitoneal Metastasis

Question 22

Why is Cryopreservation of Ejaculate Recommended in Patients with Testicular Tumours?

Answer 22

Cryopreservation AKA Sperm Freezing

• Recommended as Testicular Tumours occurs in Young Men of FERTILE AGE
• So Treatment with Chemotherapy / Radiotherapy will IMPAIRE Spermatogenesis of the ONLY Testicle

Question 23

Why is Cryopreservation of Ejaculate Recommended in Patients with Testicular Tumours?