Pathology of male genitalia Flashcards
conditions: undescended testes, balanitis, urinary rentention, uretheral strictures, phimosis, paraphimosis, hypospadias, epispadias, condyloma accuminatum, urethral discharge
Balanitis def + the most common causes
*Inflammation of glans penis.
Causes:
1. Candidiasis - intercourse, white non-urethral discharge.
2. Dermatitis - contact, allergic, eczema, psoriasis
3.Bacterial -> painful, staphylococcus
4.Anaerobic -> itchy yello non urethral discharge
5. Lichen sclerosis ( balanitis xerotica obliterans)
Investigation + management: balanitis
+ clinical diagnosis, M+S for bacteria or candida albicans
Treatment:
* hygiene
* candidiasis -> clotrimazole
*bacterial -> flucloxacillin
*Anaerobic -> metronidazole
* Dermatitis - mild topical steroid.
Undescended testes management
- Bilateral at birth -> urgent referral peds + surgery within age 6 months if still undescended by 3 months.
- Unilateral -> review 6-8wks of age, remains undescended at 3 months + surgery.
- testis descended but retractile = annual follow up in childhood = risk of ascending testes.
DIfferential diagnosis (3)
- Retractile testes:
testes in scrotum but can retract to inguinal canal - when cremaster muscle contracts. - Inguinal hernias
palpable mass in inguinal region - crying pain
*Ectopic testes
testes gone into abnormal positions - perineum or femoral region
Urethral discharge - causes + symptoms
Causes:
1. Gonorrhoea
2. Chlamydia
3. Non- specific urethritis or Non-gonococcal urethritis
Symptoms:
* Dysuria
*Pruritis
*Haematuria
Urethral discharge Ix + Tx
Urinalysis
Urine culture
PCR for specific pathogens
Blood tests
TX:
Abx
pain relief + anti histamines
Partner notif
Acute urinary retention - Cause + management
- anesthesia for surgery
- BPH
*strictures
*drugs -> anticholinergic drugs.
*alcohol.
*infective causes
tx:
-Obstructive : Turp, alpha blockers, 5 - alpha reductase inh
-Infective : abx
- Neurogenic : sacral neuromodulation, urinary diversions
Acute urinary retention -> IX + symptoms
+ Bladder scan, DRE, urinalysis, evaluation of post-void residual, blood tests (FBC, renal profile, CRP).
Symptoms/signs:
* Inability to pass urine
*lower abdominal discomfort
*pain or distress
*Suprapubic tenderness/mass (enlarged bladder)
chronic urinary retention: cause + Tx
Causes:
BPH
Prostate cancer
Drugs - antihistamines,anticholinergics or antispasmodics
Chronic urinary rentetion : IX + Symptoms
Ix:
Urinalysis
Uroflowmetry
Urodynamic studies
Cystoscopy
Urinalysis - infection.
Symptoms:
*storage and voiding + nocturnal enuresis, lower abdominal swelling.
chronic urinary retention: differential diagnosis
*Overactive bladder
*Bladder stones - dyuria
* Urethral stricture - slow urine stream, straining
*neurogenic bladder - incomplete bladder emptying.
chronic urinary retention - differences between high pressure and low pressure
High - impaired renal function + bilateral hydronephrosis
- Due to bladder outflow obstruction
Low - normal renal function + no hydronephrosis
Balanopsthitis - def + causes
Inflammation of glans penis + prepuce.
Causes:
- bac – strep,staph
-fungal - candida species
-Viral -HPV, HSV
-phimosis
-derm conditions
Balanoposthitis - symptoms + Tx
Symptoms:
* Redness and swelling
*Pain or discomfort
*itching
*foul- smelling discharge
* phimosis difficult retracting foreskin
Tx:
1. Abx
2. Kept clean - avoid soaps
3. treat underlying problem.
Balanoposthitis - Ix + differential diagnosis
Ix - swab
DD:
Penile carcinoma
Contact dermatitis
Psoriasis
Genital herpes
Genital warts
Lichen sclerosus
Urethral strictures: Causes + Mx
Idiopathic
Traumatic placement of urinary catheters
STI
penile fractures
hypospadias
lichen sclerosus
MX
Dilation
Endoscopiv urethrotomy
Urethral strictures - features + ix
features:
Decreased urinary stream
incomplete bladder emptying
less common symptoms including spraying of urinary stream and dysuria
Ix
uroflowmetry
ultrasound postvoid residual (PVR) measurement
Definition of urethral stricture
Scar tissue around the section of the urethra causes Narrowing.
Def of condyloma accuminatum and what causes it.
A benign sexually transmitted disease in wart form.
Caused by:
- HPV type 6
WHat can be seen on histology of condyloma accuminatum
- A treelike pattern of fibrovascular core and papillomatous pattern of growth.
Risk factors for condyloma accuminatum
- drug induced immunosuppression
*HIV
How does HPV cause problems in condyloma acuminatum
Mucotanous surface of the genital
Infects keratinocytes in skin + epithelial cells in muscosa to proliferate. - visible lesion
Causes - koilocytosis hyperkeratosis, parakeratosis, and acanthosis.
Treatment for Condyloma acmuniatum
Pdophyllotoxin
imiquimod cream
cryotherapy
Electrosurgeyr
Def of hypospadias and epispadias
Hypo: abnormal urethral opening on DISTAL VENTRAL surface of penis
Epi: DORSAL surface of the penis
what is the clinical significance of hypospadias
- urinary tract obstruction
- increased risk of ascending utis
- cant normally ejaculate + failure of insemination = sterility.
what is hypospadias associated (conditions) with + tx?
Undescended testes
malformation of urinary tract
Tx:
corrective surgery - do not circumcise before it
Phimosis caused by:
- accumlation of smegma + lack of hygiene (2ndary phimosis)
- Balanoposthitis
- Balanitis xerotica obliterans
treatment : phimosis
Circumcision (definitive)
topical steroid creams
good hygiene
In children less than 2 - will resolve w time.
Paraphimosis def + causes:
def : foreskin retracted behind glans penis BUT cannot come back over glans.
Cause:
Iatrogenic - penis exam, catheters.
Paraphimosis : treatment + complications
Tx: Circumcision
complications:
- Severe pain
- vasucalr engorgement
- Oedema
Balanitis xerotica obliterans - penile lichen sclerosus ; what is it
A chronic atrophic mucocutanous condition of epidermis + dermal connective tissue of genital + perianl skin
what condition is BXO associated w
Penile carcinoma
Treatment for BXO
- circumcison
- laser therapy
- Topical steroids
- Antifungals.
