penile cancer

Question 1

what does the multi-dimensional assessment of male sexual function (MSD) ?

Answer 1

desire (libido)
arousal (erection)
orgasm (ejaculation)
satisfaction ( sensation)

Question 2

what is the definition of male sexual dysfunction ?

Answer 2

the consistent or recurrent inability of a man to attain and/or maintain a penile erection sufficient for sexual performance

Question 3

how does an erection happen ?

Answer 3

release of nitric oxide due to sexual arousal which reaches the blood vessels that are present in the penis that pass through the corpora cavernosa and cause vasodilatation
this blood is then trapped by the constriction of the veins and an erection is maintained

Question 4

how is diabetes associated with erectile dysfunction ?

Answer 4

the corpora cavernosa becomes fibrotic and an erection can no longer be maintained or attained , this disease is called Peyronie’s disease

Question 5

how can trauma cause erectile dysfunction ?

Answer 5

by affection of the peudendal artery

Question 6

how can we identify if the cause of the erectile dysfunction is psychogenic or organic ?

Answer 6

by asking the patient if they have a morning erection
if they do - psychogenic
don’t- organic cause

Question 7

what diseases can put the patient at a higher risk of having ED ?

Answer 7

obesity 
hypertension 
atherosclosrosis 
dislipidemia 
metabolic syndrome 
insulin resistance 
any type of neurogenic disease

Question 8

how does metabolic syndrome cause erectile dysfunction ?

Answer 8

metabolic syndrome decreases testosterone levels which in turn increases insulin resistance

Question 9

what is the normal duplex speed of both arteries and veins in the penis ?

Answer 9

arteries : 35cm/s

veins : 0 cm/s

Question 10

affection in the penile artery ?

Answer 10

arterial disease

Question 11

affection of the venous system ?

Answer 11

veno-occlusive disease

Question 12

how should ED be treated ?

Answer 12

1. first treat the underlying disease, correct diabetes , correct hyperlipidemia etc.
2. phosphodiesterase inhibitors can be used to maintain erection

Question 13

in the case of failure of medical treatment what other options are available for ED ?

Answer 13

1. local intra-corporal injection which increases vasodilatation
2. penile implants placed in corpora cavernosa

Question 14

how do phosphodiesterase inhibitors work ?

Answer 14

works by inhibiting the enzyme that breaks down nitrogen oxide , which allows for the maintenance of the erection

Question 15

what is the first line therapy for erectile dysfunction ?

Answer 15

PDE5

Vacuum devices

Question 16

what is the 2nd line therpay for ED ?

Answer 16

1. intraurethral alprostadil (vasodilator)

2. Intracavernous injections

Question 17

what is the third line of therapy in ED ?

Answer 17

penile prosthesis implantation

Question 18

what is the prevalence and nature of penile cancer ?

Answer 18

rare but aggressive disease due to early metastasis to inguinal lymph nodes

Question 19

what type of cancer are penile carcinomas ?

Answer 19

squamous cell carcinoma of the glans of the inner layer of the prepuce

Question 20

what is the origin of the squamous cell carcinoma ?

Answer 20

non keratinized epithelium of the glans or the inner layer of the prepuce

Question 21

what is the pathology associated with penile cancer ?

Answer 21

chronic viral infection
or
chronic inflammation

Question 22

what type of chronic viral infection can cause penile cancer ?

Answer 22

most commonly caused by HPV ( ward formation)

Question 23

what type of chronic inflammation can cause penile cancer ?

Answer 23

posthitis - prepuce inflammation

balanitis - inflammation of the glans

Question 24

what can be done to reduce the risk of penile cancer ?

Answer 24

1. Circumcision
2. HPV vaccination
3. proper genital hygiene

Question 25

what is the most important concept to work with once surgically treating penile cancer ?

Answer 25

as much organ perservation as possible

as much radicality as possible

Question 26

how should a diagnosis of penile cancer be confirmed ?

Answer 26

biopsy and staging

Question 27

what is the best managemnt for penile cancer limited to the inner layer of the prepuce ?

Answer 27

radical circumscion

Question 28

what is the best surgical managemnt for superficial tumors of the glans limited to the epithelium ?

Answer 28

treated by focal chemotherapy , the glans should be spared

Question 29

how can cosmetic results be achieved when repairing the glans ?

Answer 29

split thickness skin graft
or
buccal mucosal fat

Question 30

what is the disadvantage of cosmetic surgery with the glans ?

Answer 30

lack of sensory innervation

Question 31

if a penile tumor is graded T2 which structure in the penis has it invaded to ?

Answer 31

corpus spongiosum

Question 32

if a tumor is graded T3 which structure of the penis has it invaded to ?

Answer 32

corpora cavernosa

Question 33

what is the best surgical management for a T2 or T3 penile cancer ?

Answer 33

glans amputation

Question 34

what is the most appropriate surgical management for a T4 penile tumor ?

Answer 34

requires extensive amputation

Question 35

what is the best management for limited LN metastasis ?

Answer 35

radical lymphadenectomy along with adjuvant chemotherapy

Question 36

what are the types of viagra ?

Answer 36

sildenafil
tadalafil
vardenafil