PENILE AND URETHRAL DISORDERS Flashcards
- What is the corpus cavernosum?
2. What is the corpus spongiosum and what runs through it?
- Corpus cavernosum
- Two columns of tissue that run along side the penis that helps with erections - Corpus spongiosum
- Column of sponge like tissue that runs along the front and ending at the glans
- The urethra runs through the spongiosum
Disorders of the Urethra
4
- Urethritis
- Urethral stricture
- Meatal stenosis
- Hypospadius
Urethritis
- What is it?
- Who is it more common in?
- Causes? 5
- An inflammation of the urethra
- Females greater than males
- Causes
- Gonorrhea
- Chlamydia
- HPV
- Herpes simplex
- Idiopathic
Urethritis
Symptoms:
1. Males? 4
2. Females? 4
Symptoms
- Males
- Dysuria
- Itching or burning at the meatus
- Hematuria/hematospermia
- Urethral discharge - Females
- Frequency
- Dysuria
- SP discomfort
- discharge
Urethritis
1. Dx? 2
- Tx? (first line and FL alternative)
- Alternatives? 2
- Diagnosis
- UA and culture
- NAATs - Treatment
- Azithromycin 1g PO single dose
- Doxycycline 100mg bid x 7 days - Alternatives
- Erythromycin 500mg PO qid x 7 days
- Levofloxacin/Cipro 500mg PO once daily x 7 days
Urethritis
Treatment considerations? 4
- Treat partner
- Use condoms
- Avoid irritants
- NSAIDs
Urethral Stricture
- What is it?
- What are the two types?
- A fibrotic band of tissue that renders the normal compliant urethral lumen inelastic
- Narrowing of the urethra with slowing of the urine
- Two types
- Anterior: Begins at the bulbar urethra and end at the meatus
- Posterior: Involves the membranous and prostatic urethra
Urethral Stricture
Etiologies?
3
- Trauma
- Iatrogenic
- Infection
How would the following cause urethral stricture?
- Trauma? 2
- Iatrogenic? 2
- Infection? 2
- Trauma
- Anterior urethra: Straddle injuries and penetrating injuries
- Posterior urethra: Urethral disruption from pelvic fracture - Iatrogenic
- Catheterization
- Surgical - Infection
- Gonococcal/Chlamydia
Urethral strictures:
1. Presentation? 3
- Diagnosis? 3
- Obstructive urinary symptoms
- Slow stream
- Decreased caliber
- Post-void dribbling - Dx
- Catheter
- Cystoscopy
- RUG
Urethral stricture: Tx? 3
- Urethral dilation
- DVIU
- Urethroplasty
Meatal Stenosis
- What is it?
- More common in who?
- Causes? 2
- Symptoms? 3
- Dx?
- Tx?
- Narrowing of the opening of the urethra at the tip of the penis
- More common in males
- Causes
- Swelling and irritation after newborn circ
- Idiopathic - Symptoms
- Spraying of stream
- Bed wetting
- Dysuria - Diagnosis
- Physical exam - Treatment
- Meatonomy
Hypospadius
- What is it?
- Occurs between what?
- Presentation? 3
- A congenital defect in which the opening of the urethra is on the underside of the penis
- Occurs between the glands and penile-scrotal junction
- Presentation
- Spraying of urine
- Having to sit down to void
- Foreskin makes the penis look like it has a “hood”
Hypospadius
- DX?
- Tx?
- Tx complications? 2
- Diagnosis
- Made usually at time of birth with physical exam - Treatment
-Surgical repair (4-18 months)
(Magpi and Snodgrass) - Complications
- Meatal stenosis
- Fistula
What are the penile disorders? 5
- Balanitis
- Phimosis
- Paraphimosis
- Peyronie’s Disease
- Erectile Dysfunction
Balanitis
- What is it?
- Who is most affected?
- Causes? 2
- Presentation? 3
- Inflammation of the glans penis
- Uncircumcised men with poor hygiene most affected
- Causes
- Infectious
- Non-infectious - Presentation
- Pain
- Irritation
- Itching/Burning
Balanitis
- PE findings? 3
- Dx? 3
- Tx? 4
- Physical Exam
- Erythema/Edema
- Discharge
- Ulceration - Diagnosis
- Culture discharge
- Wet mount
- Potassium hydroxide - Treatment
- Retraction of foreskin/wash with soap and water
- Bacitracin if bacterial infection suspected
- Topical clotrimazole for candidal infection
- Circumcision
Phimosis
- What is it?
- In children how may this progress?
- Causes? 2
- Complications? 4
- Inability to retract the foreskin over the glans due to narrowing, constriction, or adhesions
- In children phimosis may resolve on own
- Causes
- Balanitis
- Poor hygiene - Complications
- Balanitis
- Paraphimosis
- Voiding problems
- Penile carcinoma
- Phimosis
Presentation? 4 - Tx? 2
- Presentation
- Erythema
- Itching
- Discharge
- Pain with erection and intercourse - Treatment
- Betamethasone cream 0.05% bid
- Circumcision (alternative)
Paraphimosis
- What is it?
- Untreated can lead to what?
- Tx? 2
- Retracted foreskin becoming trapped proximal to the glans resulting in edema, inflammation, and pain
- Untreated can lead to ischemia of the glans and eventual gangrene
- Treatment
- Firm compression and manual reduction of the foreskin
- Circumcision
Peyronie’s Disease
- What is it?
- Usually affects men of what age?
- Causes? 2
- How many phases are there?
- A curvature of the penis, particularly during erections.
Fibrosis and plaque formation of the tunica albuginea - Usually affects men aged 40-70 years old
- Cause
- Vascular trauma
- Injury to the penis - Acute and chronic phase
Describe the acute (4) and chronic (3) phases of Peyronie’s Disease?
1. Acute: first 18-24 hours Includes -penile pain, -some curvature, -penile nodule, and -inflammation
2. Chronic Characterized by -stable plaque, -penile angulation, and -loss of erectile ability
Peyronie’s Disease
Presentation? 5
Presentation
- Penile pain
- Penile angulation
- Palpable plaque
- Indentation in the shaft
- Decreased erectile dysfunction
Peyronie’s Disease
- Tx if dx in the first 6 months? 3
- Tx after 6 months with a stable plaque? 2
- Treatment: If diagnosed in first 6 months
- Vitamin E
- Ibuprofen
- Colchicine - After 6 month with stable plaque
- Injection therapy
- Surgery
Peyronie’s Disease
What kind of injection therapy?
2
- Collagenase clostridiu histolyticum (Xiaflex)- Men with palpable plaque and at least 30 degree curvature
- Verapamil
Weekly injections for 6 weeks
ED Definition?
Inability to achieve or maintain an erection for satisfactory sexual performance
Pathophysiology: Normal erectile response
5 steps
- Interaction between neurotransmitter, biochemical, and smooth muscle response
- Initiated by parasympathetic and sympathetic neuronal triggers
- Integrate physiologic stimuli of the penis with sexual perception and desire
- Nitric oxide produced from endothelial cells after parasympathetic stimuli triggers smooth muscle relaxation and arterial influx of blood
- Compression of venous return follows producing an erection
- ED risk factors? 5
2. Dx? 5
- Risk factors
- HTN
- Smoking
- Diabetes mellitus
- Hyperlipidemia
- Obesity - Diagnosis
- International Index of Erectile Function Questionnaire
- Fasting serum glucose
- Lipid panel
- TSH
- Testosterone level
ED Tx
- First line?
- First line medications? 5
Treatment
1. First-line
Lifestyle modifications
2. First-line medications Phosphodiesterase type 5 (PDE5) inhibitors -Sildenafil (Viagra) 50-100mg -Tadalafil (Cialis) 5mg daily or 10-20mg -Vardenafil (Levitra) 10-20mg -Avanafil (Stendra) 50-200mg
ED First-line medications
Phosphodiesterase type 5 (PDE5) inhibitors: SE?
5
Side-effects
- HA,
- flushing,
- rhinitis,
- abnormal vision
- Do not take with nitrates
Second line for ED? 3
Third line for ED? 1
- Second line
- Alprostadil (Caverject)
- Vacuum pump device
- Muse 125-1000mcg intraurethrally - Third-line and last
- Inflatable penile prosthesis
Where do you want to inject a vasoactive substance in the penis?
Into the corpus cavernosum in a dorsolateral location