Penile conditions

Question 1

What is balano-posthitis?

Answer 1

Inflammation of glans penis, and sometimes to the underside of the foreskin

Question 2

What are the causes of balano-posthitis?5

Answer 2

Candidial
Bacterial
Contact/allergic dermatitis
Eczema/psoriasis
Lichen sclerosus

Question 3

What is the presentation of candidial balanitis?

Answer 3

Very common
Usually post intercourse
Itchy with white, non urethral discharge

Question 4

What is the presentation of bacterial balanitis?

Answer 4

Common
Usually staph. species
Painful and can be itchy
yellow, non urethral discharge

Question 5

What is the presentation of contact/allergic balanitis?

Answer 5

Very common
Itchy, sometimes painful
Occasionally clear, non urethral discharge
Often no other areas affected

Question 6

What is the presentation of eczema/psoriatic balanitis?

Answer 6

Very itchy
Np discharge
PMH eczema/psoriasis
Usually other skin areas affected

Question 7

What is the presentation of lichen sclerosus?

Answer 7

White plaques, itchy

Can cause significant scarring

Question 8

What investigations are done for balano-posthitis?

Answer 8

Usaully clinical diagnosis

Swab for microscopy and culture if suspect bacterial/candidial

Question 9

What is the general management of balano-posthitis?

Answer 9

Gentle saline washes, ensuring to wash properly under foreskin
Severe= short course 1% hydrocortisone

Question 10

What is the management of candidial balano-posthitis?

Answer 10

Topical clotrimazole for 2 weeks

Question 11

What is the management of bacterial balano-posthitis?

Answer 11

Oral flucloxacillin

Question 12

What is the management of dermatitis balanitis?

Answer 12

Mild topical corticosteroid

Question 13

What is the management of lichen sclerosus?

Answer 13

High potency topical steroid

Recurrent= circumcison

Question 14

What is hypospadias?

Answer 14

Opening of urethra on underside of penis

Question 15

What is the management of hypospadias?

Answer 15

Surgery before age 2

DO NOT circumcise before this, foreskin can be used in correction

Question 16

What is priapism?

Answer 16

Persistent penile erection, typically lasting >4 hours and is not associated with sexual stmulation

Question 17

What are the 2 types of priapism?

Answer 17

ISchaemia= impaired vasorelaxation and reduced outflow --> congestion
Non-ischaemic= high arterial inflow, due to fistula formation

Question 18

What are the cause of priapism?

Answer 18

Idiopathic
Sickle cell disease
Erectile dysfunction medication
Other drugs
Trauma

Question 19

What is the presentation of priapism?

Answer 19

Persistent erection

Pain localised to penis

Question 20

What investigations are done for priapism?

Answer 20

Largely clinical diagnosis
Cavernosal blood gas analysis= distinguish between ischaemic and non-ischaemic
FBC and toxicology= distinguish cause

Question 21

What is the management f ischaemic priapism?

Answer 21

Medical emergency
Aspiration of blood from cavernous, often with saline flush
Failure= injection of vasoconstrictive agent
Failure= surgery

Question 22

What is the management of non-ischaemic priapism?

Answer 22

Observation

Question 23

What is phimosis?

Answer 23

Foreskin cannot be pulled back past glans penis

Common in children, usually resolves by age 3 and almost always by puberty

Question 24

What is the presentation of phimosis?

Answer 24

Ballooning during micturition
Pain during erection
Unable to retract foreskin

Question 25

What is the management of phimosis?

Answer 25

Normally none until puberty
1st= topical steroid cream and gentle stretching
2= surgery

Question 26

What are the complications of phimosis?

Answer 26

Paraphimosis
Balanitis
Urinary retention