5.06 Urology - Other Flashcards
What is Fournier’s gangrene?
A rapid necrotising faciitis affecting the perineum.
Commonly caused by Group A steptococcus and Escherichia coli.
Mortality up to 40%.
What are the risk factors of Fournier’s gangrene?
- diabetes mellitus
- excess alcohol intake
- poor nutritional state
- excess steroid use
- haematological malignancies
- recent trauma
What are the clinical features of Fournier’s gangrene?
- severe pain
- pyrexia
- skin necrosis around perineum
- haemorrhagic bullae
- rapid deterioration / septic shock
How is Fournier’s gangrene investigated?
- CRP
- FBC
- U&Es
- CT imaging to show fascial swelling / soft tissue gas
How is Fournier’s gangrene managed?
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.
What is paraphimosis?
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.
What are the risk factors for paraphimosis?
- phimosis
- urethral catheter
- poor hygiene
- prior paraphimosis
What are the clinical features of paraphimosis?
- progressive pain and swelling
- unable to retract foreskin over glans
How is paraphimosis managed?
- euitable analgesia (e.g. penile block)
- manual reduction
- dorsal slit
- emergency circumcision
Paraphimosis is a urological emergency.
What is the most common penile malignancy?
Squamous cell carcinoma
Other types include basal cell carcinoma, melanoma or urethral carcinoma.
What are the risk factors for penile cancer?
- HPV (6, 16 and 18)
- phimosis
- smoking
- untreated HIV
Circumcision is deemed protective.
What are the clinical features of penile cancer?
- lesion on penis (palpable or ulcerating)
- painless
- discharge / bleeding
OE inguinal lymphadenopathy.
How should penile cancer be investigated?
Refer to specialist regional centre for penile biopsy and CT-CAP.
How is penile cancer managed?
Most commonly treated surgically - amputation or total penectomy.
Neoadjuvant radiotherapy / chemotherapy may be required.
What is Peyronie’s disease?
A condition characterised by the acquired curvature of the penis due to fibrosis of the tunica albuginea.
What are the risk factors for Peyronie’s disease?
- increasing age
- diabetes mellitus
- ischaemic heart disease
- hypertension
What are the clinical features of Peyronie’s disease?
- significant curvature / shortening of penis
- erectile dysfunction
- painful erection
How is Peyronie’s disease managed?
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.
What are the complications of Peyronie’s disease?
- high psychological burden
- emotional stress
- depression
- anxiety
Define priapism.
An unwanted and painful erection of the penis, not associated with sexual desire, lasting for more than four hours.
What are the causes of priapism?
- idiopathic (50%)
- iatrogenic
- sickle cell disease
- pelvic malignancy
What are the clinical features of priapsim?
- ongoing and unwanted erection
- absence of sexual desires
- painful erection
What is the pathophysiology of a penile fracture?
The traumatic rupture of the corpus cavernosa and tunica albuginea in an erect penis, often caused by blunt trauma.
What is the common mechanism of injury of penile fracture?
Slipping of the penis from the vagina / rectum, with a forceful thrusting to the pubic symphysis or perineum of the partner.
What are the clinical features of penile fracture?
- popping sensation
- immediate pain
- swelling
- detumescence
OE penile swelling and discolouration.
How is penile fracture managed?
- analgesia
- anti-emetics
- surgical exploration and repair
Abstinence from all sexual activities for 6-8 weeks is recommended post surgery.
What are the common complications of penile fractures?
- penile curvature during erection
- penile paraesthesia
- dyspareunia (painful erection)
