Penile and Urethral Disorders Flashcards
1
Q
What is the corpus cavernosum? Corpus spongiosum?
A
- corpus cavernosum: 2 columns of tissue that run along side of penis that helps w/ erections
- corpus spongiosum: column of sponge like tissue that runs along front and ending at glans, urethra runs through the spongiosum
2
Q
What is urethritis? Causes?
A
- an inflammation of the urethra
- females greater than males
- Causes:
gonorrhea
chlamydia
HPV
herpes simplex
idiopathic
3
Q
Sxs of urethritis in males and females?
A
- males: dysuria itching or burning at the meatus hematuria/hematospermia urethral d/c
- females: frequency dysuria SP discomfort d/c
4
Q
Dx and tx of urethritis?
A
- dx:
UA and culture
NAATs
-tx: azithro 1 g PO single dose doxy 100mg bidx 7 days - alt: erythromycin 500mg PO qidx 7days levofloxacin/cipro 500 mg once dailyx 7 days - tx partner - use condoms avoid irritants - NSAIDs - avoid acidic foods
5
Q
What is a urethral stricture?
A
- a fibrotic band of tissue that renders the normal compliant urethral lumen inelastic
- narrowing of urethra w/ slowing of urine
- 2 types:
anterior: begins at bulbar urethra and ends at meatus (straddle injuries, falling off of a bike)
posterior: involves membranous and prostatic urethra
6
Q
Etiology of urethral strictures?
A
- trauma:
anterior urethra - straddle injuries, penetrating injuries
posterior urethra - urethral disruption from pelvic fracture - iatrogenic: catheterization, surgical
- infection:
gonococcal/chlamydia
7
Q
Presentation and dx of urethral strictures?
A
- presentation: obstructive urinary sxs - slow stream decreased caliber post-void dribbling - dx: catheter (if able to cath - doesn't have stricture) cystoscopy RUG
8
Q
Tx of urethral stricture?
A
- urethral dilation
- DVIU
- urethroplasty
9
Q
What is a meatal stenosis? Causes? Sxs? dx? Tx?
A
- narrowing of opening of urethra at tip of penis
- more common in males
- Causes:
swelling and irritation after newborn circ, idiopathic - sxs:
spraying of stream
bed wetting
dysuria - dx:
physical exam - Tx:
meatonomy
10
Q
What is hypospadius? How common is this? Presentation?
A
- congenital defect in which opening of urethra is on underside of penis
- 1/300 boys
- 14% siblings
- 8% in offspring
- occurs b/t glands and penile scrotal jxn
- presentation:
spraying of urine
having to sit down to void
foreskin makes penis lool like it has a hood
11
Q
Dx and tx of hypospadius?
A
- dx: made usually at time of birth w/ PE
- tx:
surgical repair (4-18 months)
magpi
snodgrass (complications - meatal stenosis, fistula) - don’t circumcise - need skin to repair
12
Q
What is Balanitis? Causes? Presentation?
A
- inflammation of glans penis
- uncircumcised men w/ poor hygiene most affected
- 3-11% of males
- causes:
infectious
non-infectious - presentation:
pain
irritation
itching/burning
13
Q
PE, dx and tx of balanitis?
A
- PE: erythema/edema D/C ulceration - dx: culture d/c wet mount KOH -tx: retraction of foreskin/wash w/ soap and water bacitracin if bacterial infection suspected - topical clotrimazole for candidal infection - circumcision - especially if recurrent
14
Q
What is Phimosis? Causes? Complications?
A
- inability to retract foreskin over glans due to narrowing, constriction, or adhesions
- in kids phimosis may resolve on own
- 1-5% of male by age of 16
- causes:
balanitis
poor hygiene - complications:
balanitis
paraphimosis
voiding problems
penile carcinoma
15
Q
Presentation and tx of phimosis?
A
- presentation: erythema itching d/c pain w/ erection and intercourse - tx: betamethasone cream 0.05% bid circumcision (alt)
16
Q
What is paraphimosis? Tx?
A
- retracted foreskin becoming trapped proximal to glans resulting in edema, inflammation, and pain
- untx can lead to ischemia of glans and eventual gangrene
- tx:
firm compression and manual reduction of foreskin, circumcision
17
Q
What is Peyronie’s Disease? Cause?
A
- curvature of penis, particularly during erections
- fibrosis and plaque formation of tunica albuginea
- usually affects men aged 40-70 yo
- cause:
vascular trauma
injury to penis
18
Q
Acute and chronic phase of peyronie’s disease?
A
- acute: first 18-24 hrs - includes penile pain, some curvature, penile nodule, and inflammation
- chronic: characterized by stable plaque, penile angulation, and loss of erectile ability
19
Q
Presentation of peyronie’s disease?
A
- penile pain
- penile angulation
- palpable plaque
- indentation in shaft
- decreased ED
20
Q
Tx of peyronie’s disease?
A
- if dx in first 6 months:
Vitamin E
ibuprofen
colchicine
after 6 month w/ stable plaque: -injection therapy: collagenase clostridiu histolyticum (Xiaflex) - men w/ palpable plaque and at least 30 degree curvature -verapamil: weekly injections for 6 wks - surgery
21
Q
What is ED? Prevalence?
A
- inability to achieve or maintain an erection for satisfactory sexual performance
- MC sexual problem in men: affect relationships, quality of life, self-esteem
- prevalence:
under 59: 12%
60-69: 22%
over 69: 30%
22
Q
Normal erectile response?
A
- interaction b/t neurotransmitter, biochemical and smooth muscle response
- initiated by parasympathetic and sympathetic neuronal triggers
- integrate physiologic stimuli of penis w/ sexual perception and desire
- nitric oxide produced from endothelial cells after parasympathetic stimuli trigger smooth muscle relaxation and arterila influx of blood
- compression of venous return follows producing an erection
23
Q
RFs of ED?
A
- HTN
- smoking
- DM
- hyperlipidemia
- obesity
24
Q
Dx ED?
A
- international index of erectile fxnl questionnaire
- fasting serum glucose
- lipid panel
- TSH
- testosterone level
25
Tx of ED?
- 1st line: lifesyle modifications - tx HTN, exercising, diet
- 1st line meds:
PDE5 inhibitors -
sildenafil (viagra) 50-100mg
tadalafil (cialis) 5mg daily or 10-20 mg
vardenafil (levitra) 10-20 mg
avanafil (steward) 50-200 mg
-SE: HA, flushing, rhinitis, abnormal vision
- Don't take w/ nitrates
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-2nd line:
alprostadil (caverject) injection (SE: priapism)
vacuum pump device
muse 125-100-mcg intraurethrally
- 3rd line and last:
inflatable penile prosthesis
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