Penile Disorders Flashcards
What are the 3 main parts of the penis?
Where is the penis attached the to main body?
Root
Body/shaft
Glans
Root is fixed to the superficial perineal pouch of pelvic floor
What are the 2 types of erectile tissue of the penis?
Corpus spongiosum-> bulb proxmially and contains the urethra and expands distally to form the glans which has the external urethreal orifice
Corpus cavernosa -> arise from the crus of the penis proximally
What 2 pelvic floor muscles are associated with the penis and what function do they have?
Ischiocavernosus
-contracts to squeeze blood from the cavernous space in the crus into the corpus cavernosa to help MAINTAIN AN ERECTION
Bulbospongiosum
-contracts to empty the urethra of urine or semen
What is the origin of arterial supply to the penis?
What are the main arteries supplying the penis?
Internal iliac artery= origin of arteries supplying the penis
Internal pudendal artery arises from interal iliac artery to give off 3 branches:
- Deep arteries
- dorsal arteries
- bulbourethral arteries
What is the venous drainage for the penis?
Deep and superficial dorsal veins of penis
What is the nervous supply to the penis?
Arise from S2-4
Sensory + somatic:
Dorsal nerve of penis arised from pudendal nerve
Parasympathetic:
-cavernous nerves from peri-prostatic plexus
What are the 3 forms of fascia present in the penis and what is their role?
Colles fascia
- superficial fascia
- contains the superficial dorsal vein of penis
Buck’s fascia
-deep layer of fascia
Tunica albuginea
- surrounds the erectile tissue of penis i.e. corpus cavernosum and corpus spongiosum
- meets in middle of corpus cavernosa to form septum
What is phimosis?
What are the 2 times it can occur?
How might somone present?
How is it managed?
Tight prepuce (foreskin) over the glans meaning it cannot be retracted
Physiological
-normal up to 2 years old
Pathological
- when starts to cause problems i.e. urinary obstruction/haematuria/pain/infection
- can occur due to infection due to poor hygeine
Presents:
- painful erection
- haematuria
- pain around prepuce
- weak urinary stream
Management:
- conservative i.e. wait in physiological instance for it to resolve or encourage better hygeine to clean foreskin
- surgical i.e. circumcision or plastic surgery
What is paraphimosis?
What causes it?
Why is it an emergency?
Tight prepuce retracted over the glans but is not able to be replaced due to swollen glans
Glans swells due to tight constricting band of foreskine preventing venous drainage
Cause:
- failing to replace foreskin after catheterisation
- repeated forced retraction of physiological phimosis
- vigorous sexual activity
- poor hygeine
Can lead to penile ischaemia and infection if not reduced i.e. can lead to foreskin gangrene
What is hypospadias?
What is used to classify the different types and what are the 3 main types?
How is it treated?
Congenital defect leading to ventral urethral meatus due to failure of urinary channel to tuberolise properly
Duckett classification
- subcronal
- midshaft
- penoscrotal
Surgically by taking skin from prepuce after 1 yo
What is balanitis? How might someone present? What are the risk factors for balanitis? What are the common causes? How is it managed?
Inflammation of the glans
Presents with inflammed and sore glans and foreskin
RF:
- diabetes
- poor hygeine
- oral Abx
- immunosuppression
- chemical irritation
Caused by moist skin fold rubbing together-> can be due to bacterial/fungal infection/dermatitis
Management:
-treat the cause
Clotrimazole= candida infection
Hydrocortison= non-specific dermatitis
How might someone with penile cancer present?
What is the most common cancer associated with the penis?
What are the risk factors for developing?
What is a protective risk factor?
How would you investigate it?
What are the treatment options for penile cancer?
Painless, palpable/ulcerated lesions (commonly on the glans)
Inguinal lymphadenopathy-> due to inguinal lymph nodes draining the penis
Squamous cell carcinoma= most common type of cancer
HPV 16/6/18 Phimosis Smoking Lichen sclerosis Untreated HIV
Circumcision= protective against penile cancer
PET scan
Biopsy
CT TAP
TX: (aim to cure and maintain function)
- chemo
- radio
- surgery I.e. can include reconstruction
What is Peyronie’s disease?
What are the 2 stages of disease?
How might someone present?
How is it managed?
Disorder of penile connective tissue leading fibrous plaque forming in tunica albuginea
Has inflammatory stage which progresses to scarring phase
PX
- penile agulation/deformity on erection
- painful erection
- erectile dysfunction
- dyspareunia (painful sex)
MX:
- watchful waiting
- intra-lesion therapy
- minimally invasive surgery to remove
What is the definition of erectile dysfunction?
What are the risk factors for developing erectile dysfunction?
What are the 3 main causes of erectile dysfunction?
What should be considered if someone present with erectile dysfunction?
Persistant inability to attain and maintain erection sufficient to permit satisfactory sexual performance
RF:
- Sedetary lifestyle
- obesity
- smoking
- hypercholestrolaemia
- HTN
- Diabetes
ORGANIC:
- vasculogenic= CVD/HTN/hyperlipidaemia
- neurogenic= MS/PD/diabetes/pelvic surgery
- hormonal= hypogonadism/thyroid dysfunction
- anatomical
PSYCHOGENIC:
- generalised
- situational
DRUGS
- antihypertensives
- antipsychotics
- antidepressants
Erectile dysfunction can be a marker for CVD
What investigations would you do if someone was presenting with erectile dysfunction?
How can someone with erectile dysfunction be managed?
Genitourinary exam Endocrine screening CVS i.e. BP/Pulse/lipid profile DRE if >50 HbA1C
Lifestyle changes PDE-5 inhibitors (sildenfil) Vacuum devices Alprostadil (2nd line-> injection into penis) Prosthesis (3rd line)
