Anatomy: Normal and erectile dysfunction

Question 1

point and shoot

Answer 1

para - erection
symp- ejaculation

crops cavernous erectile tissue of the penis

Question 2

for artery branch of the internal iliac is needed for erection

Answer 2

internal pudendal artery

eexternal does tissue surrounding it

Question 3

venous drainage of the penis

Answer 3

prostatic venous plexus then to internal iliac artery

r testicle to IVC then left to left renal vein

variocelle of varicose vein of left testicle - scan left kidney for renal cancer

Question 4

innervation to the penis controlled by

Answer 4

somatic pudendal - conscious control
inconcisous
para - S2-4 pelvic splanchnic nerves and sympathetic is T12-L2

Question 5

all skeletal muscles are controlled by

Answer 5

the somatic nervous system

Question 6

what are the 4 parts to an erection

Answer 6

erection
ejaculation - emissions dn expulsion ( gather and fire)
remission

Question 7

normal eerection in brain

Answer 7

erotic stimulus, triggers para( pelvic splanchnic nerves stimulate pre aortic and pros tai plexuses) and act of limbic system then act on cc on penis - vasodilation of pudendla artery and deep penile arteries mediated by nitric oxide. Erectile tissue fills with blood compression the dorsal vein.

Question 8

normal ejacultion

what causes retrograde ejaculation

Answer 8

emission - initial part of ejaculation
signals from lateral horns of T10-12

sympathetic system
NA released - DD, seminal vessels nd smooth muscle of prostate contract and internal urethral sphincter constricts

final act is pudendal nerve contract and send pulses - construct arteries and pressure decrease

symathetic system constrict bladder to prevent retrograde ejacutlaiton - TURP can cause this

bulbospongioussu fire it

Question 9

erectile dysfunction causes

Answer 9

psychological 
tired 
drugs 
anxierty 
depression 
anti-hypertensives
MS 
tumorus 
larches syndrome ( button claudication)

Question 10

how does viagra work

Answer 10

sidinafil - works on NO hangs around longer so more blood filling

Question 11

phimosis

Answer 11

is a condition where the foreskin is too tight to be pulled back over the head of the penis (glans)

Question 12

paraphismosis

treatment

Answer 12

where the foreskin cannot be returned to its original position after being retracted. It causes the glans to become painful and swollen and requires emergency medical treatment to avoid serious complications, such as increased pain, swelling and restricted blood flow to the penis.

circumcission

afte rpuberty should be Abel to

squeeze penis tight to get back

Question 13

balanitis

Answer 13

pain and inflammation (swelling and irritation) of the glans (head) of the penis that happens most often in uncircumcised males
rf 
poor hygiene 
diabetes 
obese 
STI 
middle aged to older 

foul smell and smegam
painful ruination
redness

Question 14

hydrospadiads

Answer 14

hole somewhere else

don’t circumsize

Question 15

treatment for balinits

Answer 15

anti fungal tcreasm for yeast infection like clotrimazole 
antibiotics 
improved hygiene 
diabetes 
cicumcission

Question 16

What artery supplies the main body (i.e the corposa cavernosa) of the penis

What arteries is this a branch of?

Answer 16

cavernosal artery

bulbourethral artery

Question 17

What artery supplies the skin of the penis?

Answer 17

dorsal artery

Question 18

How does blood drain from the penis?

Answer 18

The deep dorsal vein receives blood from emissary veins, which arise from subtunical venules draining trabecular and passing through the tunica albuginea and circumflex veins. In the infrapubic region, the deep dorsal

Question 19

What nerves are involved in somatic (i.e. motor and sensory) pathways to/from the penis

Answer 19

pudendal

Question 20

What plexus and then nerves are involved in the sympathetic control of the penis?

Answer 20

superior hypogastric

Question 21

What nerves are involved in the parasympathetic control of the penis?

Answer 21

sacral nerve roots S2-4

Question 22

Correctly order the following stages of erection and ejaculation

Answer 22

Nitric Oxide release causes the cavernous arteries to dilate and blood flows into the corposa cavernosa and spongiosum.

· Sympathetic fibres cause the urethral bulb to expand and contract both internal and external urethral sphincters

· Sensory pudendal nerves are stimulated by sexual arousal.

· Engorgement of the corposa cavernosa constricts outflow to the deep dorsal vein maintaining erection

· The muscles of the external urethral sphincter then relax and waves of muscular contraction from the base of the penis through the urethra eject semen from the penis

· At the same time parasympathetic fibres stimulate secretion of sperm and seminal fluid.

· Parasympathetic chain stimulates eNOS to produce Nitric Oxide in the endothelium of the penis

Question 23

Stimulation of erection

Answer 23

S2-S4 pudendal nerve

Stimulation of genitals sends signals along the pudendal nerve, to the spinal cord

Somatic innervation

Erection due to parasympathetic innervation (POINT)

Pelvic splanchnic nerve stimulates pre-aortic and prostatic plexuses, which carry nerve signals to the penis

Deep penile arteries vasodilate due to nitric oxide

Erectile tissues fill the corpus cavernosum mainly with blood, compressing the dorsal veins.

Tunica albuginea also aids in preventing blood from flowing out of the corpus cavernosum

Question 24

ejaculation

Answer 24

Emission

-due to sympathetic innervation (SHOOT)

Emission= initial part of ejaculation

Signals initiated by the lateral horns of T10-L2

Lumbar and sacral splanchnic nerves carry signals via the pre-aortic and prostatic plexuses to the spermatic cords

Release of noradrenaline:
Ductus deferens, seminal vesicles (produce seminal fluid), and smooth muscle of the prostate begin to contract
Internal urethral sphincter constricts (stops urine coming out and semen up into the bladder)

Somatic innervation
Signals arise from the ventral horn of S2-S4 in the spinal cord
Motor signal carried by the pudendal nerve

Diagram

Description automatically generatedMotor nerve impulses cause bulbospongiosus and ischiocavernosus to contract rhythmathly

Question 25

case 1
27yr man with 5hr history of painful erectile
PMH SCD
smokes and takes cocaine what is it

Answer 25

Priprism - low flow probs very painful

Question 26

case 2
43yr with inflamed swollen glands, unable to retract foreskin and complains of pain on passing urine

PMH diabetes
DH metfromin and recent cause of antibiotic for chest infection

Answer 26

balanitis

Inflammation of the glans penis
If the foreskin is also inflamed, the correct term is balanoposthitis
Uncommon in circumcised males
Risk factors: diabetes, oral antibiotics, poor hygiene, immunosuppression, irritation of the glans

Causes:  
Usually simple intertrigo  
Infection  
Dermatological  
Irritation  
Trauma 
Stevens Johnson syndrome -dermatological emergency usually related to antibiotics  
Right heart failure – peripheral oedema  
Morbid obesity

Question 27

case 3

26y man on abdo surgery. unable to replace foreksin since returning from their as cathertires by junior member of staff

Answer 27

Paraphimosis
Inability to replace a retracted foreskin over the glans penis
Often due to constriction by a tight band of the foreskin
Glans become oedematous due to reduced venous return, followed by vascular engorgement of the distal penis
Urological emergency due to risk of ischaemia and infection
RF: phimosis, indwelling urethral catheter, poor hygiene, previous episodes

Question 28

case. 4
52yr with hypertension and can’t maintain erection. PMH hypertension and T2DM
DH rmaipril, bisporlol, metfomrin
smoker

Answer 28

Erectile Dysfunction
The inability to attain and maintain an erection sufficient for sexual performance
RF: obesity, smoking, lack of exercise, High blood pressure, hypercholesterolaemia, diabetes, metabolic syndrome

Causes:
Vascular, neurological, hormonal, anatomical ,medications (antihypertensives) ,psychogenic

Question 29

case 5
36yr acute penile pain. feels a popping sensation during sex with new partner, following acute swelling and detumescence
penis darker in colour than usual

Answer 29

Penile Fracture
Urological emergency- prompt intervention
Traumatic rupture of corpus cavernosum and tunica albuginea whilst the penis is erect
Causes: blunt trauma

Often reported as a popping sensation or audible snap, before immediate pain, swelling and detumescence

O/E: swelling and discolouration due to haematoma. May deviate away from the affected side

Haematoma may be palpable ‘rolling sign’. Butterfly shaped bruising to the perineum is suggestive of urethral injury