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Year 3 - Surgery > 5.06 Urology - Other > Flashcards

5.06 Urology - Other Flashcards

1
Q

What is Fournier’s gangrene?

A

A rapid necrotising faciitis affecting the perineum.

Commonly caused by Group A steptococcus and Escherichia coli.

Mortality up to 40%.

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2
Q

What are the risk factors of Fournier’s gangrene?

A
  • diabetes mellitus
  • excess alcohol intake
  • poor nutritional state
  • excess steroid use
  • haematological malignancies
  • recent trauma
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3
Q

What are the clinical features of Fournier’s gangrene?

A
  • severe pain
  • pyrexia
  • skin necrosis around perineum
  • haemorrhagic bullae
  • rapid deterioration / septic shock
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4
Q

How is Fournier’s gangrene investigated?

A
  • CRP
  • FBC
  • U&Es
  • CT imaging to show fascial swelling / soft tissue gas
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5
Q

How is Fournier’s gangrene managed?

A

Urgent surgical debridement, extensive.

Debrided tissue sent for tissue histology and culture.

Patient given broad-spectrum antibiotics (cover Gram negative, positive, aerobic and anaerobic bacteria, and MRSA covering agent).

Secondary closure with skin grafts from plastics.

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6
Q

What is paraphimosis?

A

The inability to pull forward a retracted foreskin, commonly caused by the presence of a tight constricting band that prevents retraction over the glans.

Left untreated, paraphimosis causes the glans to become overly oedematous due to reduced venous return, leading to penile ischaemia.

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7
Q

What are the risk factors for paraphimosis?

A
  • phimosis
  • urethral catheter
  • poor hygiene
  • prior paraphimosis
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8
Q

What are the clinical features of paraphimosis?

A
  • progressive pain and swelling
  • unable to retract foreskin over glans
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9
Q

How is paraphimosis managed?

A
  • euitable analgesia (e.g. penile block)
  • manual reduction
  • dorsal slit
  • emergency circumcision

Paraphimosis is a urological emergency.

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10
Q

What is the most common penile malignancy?

A

Squamous cell carcinoma

Other types include basal cell carcinoma, melanoma or urethral carcinoma.

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11
Q

What are the risk factors for penile cancer?

A
  • HPV (6, 16 and 18)
  • phimosis
  • smoking
  • untreated HIV

Circumcision is deemed protective.

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12
Q

What are the clinical features of penile cancer?

A
  • lesion on penis (palpable or ulcerating)
  • painless
  • discharge / bleeding

OE inguinal lymphadenopathy.

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13
Q

How should penile cancer be investigated?

A

Refer to specialist regional centre for penile biopsy and CT-CAP.

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14
Q

How is penile cancer managed?

A

Most commonly treated surgically - amputation or total penectomy.

Neoadjuvant radiotherapy / chemotherapy may be required.

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15
Q

What is Peyronie’s disease?

A

A condition characterised by the acquired curvature of the penis due to fibrosis of the tunica albuginea.

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16
Q

What are the risk factors for Peyronie’s disease?

A
  • increasing age
  • diabetes mellitus
  • ischaemic heart disease
  • hypertension
17
Q

What are the clinical features of Peyronie’s disease?

A
  • significant curvature / shortening of penis
  • erectile dysfunction
  • painful erection
18
Q

How is Peyronie’s disease managed?

A

Mainstay of management is to improve and maintain sexual function:
- PDE5 inhibitors
- intracavernosal injection of vasoactive medication
- vacuum erection pumps

Surgical reconstruction of penis to restore functional straightness can be considered in extreme cases.

Note only those with painful erections or limited sexual function require treatment.

19
Q

What are the complications of Peyronie’s disease?

A
  • high psychological burden
  • emotional stress
  • depression
  • anxiety
20
Q

Define priapism.

A

An unwanted and painful erection of the penis, not associated with sexual desire, lasting for more than four hours.

21
Q

What are the causes of priapism?

A
  • idiopathic (50%)
  • iatrogenic
  • sickle cell disease
  • pelvic malignancy
22
Q

What are the clinical features of priapsim?

A
  • ongoing and unwanted erection
  • absence of sexual desires
  • painful erection
23
Q

What is the pathophysiology of a penile fracture?

A

The traumatic rupture of the corpus cavernosa and tunica albuginea in an erect penis, often caused by blunt trauma.

24
Q

What is the common mechanism of injury of penile fracture?

A

Slipping of the penis from the vagina / rectum, with a forceful thrusting to the pubic symphysis or perineum of the partner.

25
Q

What are the clinical features of penile fracture?

A
  • popping sensation
  • immediate pain
  • swelling
  • detumescence

OE penile swelling and discolouration.

26
Q

How is penile fracture managed?

A
  • analgesia
  • anti-emetics
  • surgical exploration and repair

Abstinence from all sexual activities for 6-8 weeks is recommended post surgery.

27
Q

What are the common complications of penile fractures?

A
  • penile curvature during erection
  • penile paraesthesia
  • dyspareunia (painful erection)

Year 3 - Surgery (30 decks)

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