Genitourinary #6 Flashcards
MC type of penile cancer
Squamous cell carcinoma
Penile cancer is commonly associated with what risk factors? SHHL
Smoking
HIV
HPV 6, 16, and 18
Lack of circumcision
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
Diagnostics for penile cancer
Biopsy
Symptoms of penile cancer
-Mass, palpable lesion, or ulcer on penis
-Rare to bleed or rash
If the penile cancer is early, limited excision is recommended. However, if late, what is the treatment?
Penile amputation with therapeutic lymph node dissection
What is the MCC of erectile dysfunction?
Vascular (atherosclerosis, diabetes)
What are some medications that can cause erectile dysfunction?
BB
Thiazide diuretics
Spironolactone
CCB
SSRI
TCAs
If the ED is abrupt onset in nature, what is the likely culprit?
Psychological cause rather than systemic
What is the first-line therapy for ED?
Phosphodiesterase-5-inhibitors (Sildenafil, Tadalfil, and Vardenafil)
MOA of PD-5 inhibitors
-Potentiates nitric oxide mediated penile smooth muscle relaxation, leading to ability to generate and maintain erection
Adverse effects of PD5 inhibitors
-Headaches
-Flushing
-Hearing loss
-Visual disturbances
When should PD5 inhibitors NOT be used?
In conjunction with nitrates or if the patient has cardiovascular disease (may cause severe hypotension)
Second line therapy for ED
-Intracavernosal injection therapy (prostaglandin E1 Alprostadil)
Last line therapy for ED
-Penile prosthesis or corrective penile revascularization
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
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
