Genitourinary #6 Flashcards by Tyler Cichowski

MC type of penile cancer

Squamous cell carcinoma

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Penile cancer is commonly associated with what risk factors? SHHL

Smoking
HIV
HPV 6, 16, and 18
Lack of circumcision

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What is Bowen’s Disease and how is it related to penile cancer?

Leukoplakia on the shaft of penis or scrotum
Associated with HPV 16
Minority progresses to SCC

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Diagnostics for penile cancer

Biopsy

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Symptoms of penile cancer

-Mass, palpable lesion, or ulcer on penis
-Rare to bleed or rash

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If the penile cancer is early, limited excision is recommended. However, if late, what is the treatment?

Penile amputation with therapeutic lymph node dissection

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What is the MCC of erectile dysfunction?

Vascular (atherosclerosis, diabetes)

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What are some medications that can cause erectile dysfunction?

BB
Thiazide diuretics
Spironolactone
CCB
SSRI
TCAs

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If the ED is abrupt onset in nature, what is the likely culprit?

Psychological cause rather than systemic

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What is the first-line therapy for ED?

Phosphodiesterase-5-inhibitors (Sildenafil, Tadalfil, and Vardenafil)

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MOA of PD-5 inhibitors

-Potentiates nitric oxide mediated penile smooth muscle relaxation, leading to ability to generate and maintain erection

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Adverse effects of PD5 inhibitors

-Headaches
-Flushing
-Hearing loss
-Visual disturbances

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When should PD5 inhibitors NOT be used?

In conjunction with nitrates or if the patient has cardiovascular disease (may cause severe hypotension)

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Second line therapy for ED

-Intracavernosal injection therapy (prostaglandin E1 Alprostadil)

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Last line therapy for ED

-Penile prosthesis or corrective penile revascularization

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What is hypospadias?

Congenital anomaly of the male urethra that results in abnormal VENTRAL placement of the urethral opening

-Penile curvature present as well most times

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What is the pathophysiology of hypospadias?

Failure or urogenital folds to fuse during development

Symptoms of hypospadias

-Recurrent UTIs
-ED
-Deflection of urinary stream

What is the management for a patient with hypospadias?

Patients should NOT be circumcised because the foreskin can be used to repair the defect

Elective surgical correction: Performed in healthy, full-term infants ages 6 months - 1 year

On the other hand, what is epispadias?

Abnormal DORSAL placement of the urethral opening

Epispadias is often associated with what?

Bladder exstrophy (protrusion of the bladder wall through a defect in the abdominal wall)

What is the pathophysiology of epispadias

Failure of midline penile fusion

Treatment for epispadias?

Surgical correction

What is enuresis?

Episodes of urinary incontinence in children 5 years of age or older, while sleeping

What is the difference between primary and secondary enuresis?

Primary: absence of any period of nighttime dryness (MC type) Secondary: enuresis after a period of dryness of at least 6 months. Due to stressful event (divorce, birth, etc.)

First-line therapy for enuresis?

behavioral therapy (washable products, motivational therapy, education) Bladder training: regular voiding, schedule, waking child to urinate, avoid caffeine and high sugar drinks, fluid restriction

What is the most effective LONG TERM therapy for enuresis?

Enuresis alarm. Used if children fail to respond to behavioral therapy.

What are two medications that can be used in the treatment for enuresis?

Desmopressin (DDAVP): synthetic antidiuretic hormone (ADH). Reduces urination Imipramine: TCA, stimulates ADH secretion

What is priapism?

Prolonged, painful erections without sexual stimulation

MC type of priapism

Ischemic (low flow): decreased venous outflow. Painful and rigid erection. May lead to compartment syndrome.

However, the other type of priapism is

Nonischemic (high flow): increased arterial outflow. Due to fistula and commonly related to penile or perineal trauma. Less painful and not super rigid penis.

Etiologies of priapism

MC is idiopathic Others include: sickle cell disease, drugs (cocaine, marijauna, alcohol). Trauma. Trazodone, PD5 inhibitors, Alpha blockers. Head trauma. Subarachnoid hemorrhage.

What diagnostic can be done if the erection lasts longer than 4 hours?

Cavernosal blood gas (low flow shows hypoglycemia, hypoxemia, and hypercarbia)

First-line medication for priapism

Phenylephrine (intracavernosal injection). Causes contraction of cavernous smooth muscle which increases venous outflow.

Other treatments for priapism

-Needle aspiration (can be used with phenylephrine) -Ice packs -Terbutaline (if < 4 hours) -Shunt surgery saved for refractory cases

However, if the priapism is HIGH FLOW, what is the treatment?

Observation for most cases (most resolve on their own)

MC etiology of urethral injuries

Blunt trauma: straddle-type falls -Other causes: physical or sexual assault

Symptoms of a urethral injury

-Gross hematuria -Dysuria -Urinary retention -Lower abdominal pain

What is seen on physical exam of a patient with a urethral injury?

-Blood at urethral meatus -Swelling or ecchymosis of the scrotum -High-riding prostate

What is the diagnostic test of choice for a urethral injury?

Retrograde urethrogram (done prior to catheterization)

What's the hallmark triad of symptoms for a urethral injury?

-Blood at urethral meatus -Inability to void -Distended bladder

Treatment for urethral injury

-Nonoperative: catheter placement and monitoring -Operative: temporary suprapubic catheter placement prior to repair