Diseases of the penis Flashcards
Management of phimosis in a child under 2 years old
- non-retractile foreskin and/or ballooning during micturition in a child under two → an expectant approach should be taken in case this is physiological phimosis → will resolve in time
*forcible retraction can result in scar formation so should be avoided
- Personal hygiene is important
*If the child is over 2 years of age and has recurrent balanoposthitis or urinary tract infection then treatment can be considered
What’s ballooning in a boy under 2 y old?
Physiologically, a foreskin becomes retractible before age of 2
- ballooning during urination → collection of urine between the foreskin and a glans
- this is normal
Phimosis
- what is it?
- treatment
Phimosis = narrowing of the opening of the foreskin
- may result in balanitis
Treatment:
- usually circumcision
- may be conservative with topical betamethasone 0.05% cream
Paraphimosis
- what is this?
- possible cause
Paraphimosis = swelling of the gland as a result of a tight foreskin being retracted and not replaced
Cause: after catheterisation or erection
What happens: foreskin blocks the venous outflow → oedema and swelling of the glans
Pathological phimosis?
- other names (2)
- pathophysiology
aka Balanitis Xerotica Obliterans or Lichen Sclerosus of the Penis
Pathophysiology: dermatological skin condition of an unknown origin; affecting the glans and foreskin
- atrophic white patches appear and whitish ring of a harden tissue near to tip of the penis → prevents retraction
Treatment:
- Lichen sclerosus → high potency topical steroids (e.g. clobetasol).
- Circumcision
Peyronie’s Disease
- pathophysiology
- cause
Pathophysiology:
- connective tissue disorder → fibrous plaques in the tissue of the penis
- scar forms in tunica albuginea (surrounding corpora cavernosa)
Cause: not fully understood. Thought to be caused by a trauma or injury of the penis e.g. during sexual activity (patient may even not be aware the trauma has occured)
Presentation of Peyronie’s disease
- pain
- abnormal curvature
- erectile dysfunction
- indentation
- shortening
- reduced thickness
Management of Peyronie’s Disease
Conservative treatment: to help with pain and potentially slowing the disease progress (but no effect on the curvature) e.g. Verapamil, collagenase, interfreon
Mechanical modelling → a vacuum erection device and penile stretching and straightening exercises with the aim of reducing the curvature
Mechanical modelling on its own is unlikely to be beneficial but it is essential that it is performed after Xiapex injections or surgical correction of the penile curvature
Xiapex Injection therapy is the first non-surgical therapy that has proved effective in treating Peyronie’s plaque
Surgical correction →should only be performed after the disease progress has stopped which usually occurs 12 months from onset (chronic phase)
Balanitis
- pathophysiology
- cause
Pathophysiology: inflammation of the glans penis
Cause:
- most common causes are infective (both bacterial and candidal)
- autoimmune causes
Investigations for Balanitis
- majority diagnosed clinically based on the history and physical appearance of the glans penis
- if suspected infective causes a swab can be taken for microscopy and culture which may demonstrate bacteria or Candida albicans
- When there is a doubt about the cause and there is extensive skin change, then a biopsy can be helpful in confirming the diagnosis.
Treatment of balanitis
- gentle saline washes → to wash properly under the foreskin
- in the case of more severe irritation and discomfort then 1% hydrocortisone can be used for a short period
- When the cause is not clear, these measures can often resolve the condition alone
Treatment of balanitis if it is due to:
- candidiasis
- bacteria
- anaerobic bacteria
- candidiasis → topical clotrimazole which has to be applied for two weeks
- Bacterial balanitis ( Staphylococcus spp. or Group B Streptococcus spp.) → oral flucloxacillin or clarithromycin if penicillin allergic
- Anaerobic balanitis is managed with saline washing ; topical or oral metronidazole if not settling.
Management of balanitis if it is due to:
- dermatitis
- lichen sclerosus
- Dermatitis → mild potency topical corticosteroids (e.g. hydrocortisone)
- Lichen sclerosus → high potency topical steroids (e.g. clobetasol); circumcision can help
Organic and psychogenic causes of erectile dysfunction
Risk factors for erectile dysfunction
- increasing age
- cardiovascular disease risk factors: obesity, diabetes mellitus, dyslipidaemia, metabolic syndrome, hypertension, smoking
- alcohol use
- drugs: SSRIs, beta-blockers
