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Urology > Penile Pathology > Flashcards

Penile Pathology Flashcards

1
Q

what is the autonomic nerve supply involved in erection?

A

Parasympathetic (S2-S4) discharge causes erection

sympathetic (T11-L2) discharge causes ejaculation and detumescence.

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2
Q

what are the organic causes of erectile dysfunction?

A

SMOKING, ALCOHOL,
DIABETES
Also hypogonadism, hyperthyroidism, ↑prolactin, cord lesions, MS, autonomic, trauma and pelvic surgery, Radiotherapy, Atheroma, Prostatic hyperplasia, post-priapism or Pyronines

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3
Q

what drugs can cause erectile dysfunction?

A

digoxin, B-blockers, diuretics, anti-psychotics, antidepressants, oestrogens, finasteride, narcotics

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4
Q

what are the psychological causes of erectile dysfunction?

A

o Depression
o Relationship problems
o Sexual orientation uncertainties
o Primary psychogenic erectile dysfunction

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5
Q

what is the clinical feature of erectile dysfunction?

A

Inability to achieve or maintain an erection

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6
Q

what investigations are required to diagnose erectile dysfunction?

A
  • Full sexual and psychological history
  • U&E, LFTs, glucose, TFT, LH, FSH, lipids, testosterone, prolactin
  • +/- Doppler
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7
Q

what is the management of erectile dysfunction?

A
  • Treat causes
  • Counselling
  • Lifestyle
  • Medications
  • Surgery – penile implant
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8
Q

what medications are involved in the management of erectile dysfunction?

A

o Phosphodiesterase-5 inhibitors eg. Sildenafil citrate (Viagra), tadalafil, vardenafil
o Intracavernosal injections of alprostadil +/- vacuum erection device
o Intracavernosal combination – alprostadil, papaverine, phentolamine

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9
Q

what is the pathophysiology of balantis?

A

inflammation of the foreskin and glans

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10
Q

what is the cause of balantits?

A

associated with strep and staph infections, more common in diabetics. Young children with tight foreskins

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11
Q

what is the management of balantis?

A

antibiotics, circumcision, hygiene advice

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12
Q

what is the pathophysiology of phimosis?

A

foreskin cannot be retracted behind the glans, occludes the meatus

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13
Q

what are the clinical features of phimosis?

A

o Young boys: Recurrent balanitis and ballooning
o Adults: painful intercourse, infection, ulceration, balanitis xerotica obliterans
o Overgrowth of bacteria behind foreskin – smegma bacillus

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14
Q

what is the pathophysiology of paraphimosis?

A

o Foreskin becomes trapped behind the glans penis and cannot be reduced
o Prevents venous return leading to oedema and even ischaemia of the glans

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15
Q

what is the cause of paraphimosis?

A

incorrect handling of foreskin – retraction for catherization or cystoscopy and not replaced properly, sex for first time, old age you has not/cannot

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16
Q

what are the clinical features of paraphimosis?

A

painful swelling of the foreskin distal to a phimotic rim, palpable tight band

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17
Q

what is the management of paraphimosis?

A

Ask patient to squeeze glans. Try applying a 50% glucose soaked swap. Ice packs and lidocaine gel may also help. May require aspiration/dorsal slit/circumcision.
o Retraction – ring block then squeeze for 20 mins “white knuckle pressure”

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18
Q

what are the causes of priapism?

A
  • Idiopathic - 80%
  • Intracorporeal injection for ED e.g. papaverine (low flow)
  • Trauma (high flow)
  • Haematological dyscrasias e.g. sickle cell
  • Neurological conditions – spinal cord lesions
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19
Q

what is priapism?

A

prolonged priapism

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20
Q

what is the pathophysiology of low flow priapism?

A

o Excessive release of neurotransmitters, blockage of drainage venules, paralysis of the intrinsic mechanism, prolonged relaxation of the intracavernous smooth muscles
o Vascular stasis + decreased venous outflow = compartment syndrome
o Lots of deoxygenated blood in penis can cause necrosis and tissue damage

21
Q

what is the pathophysiology of high flow priapism?

A

o Fistula between the cavernosal artery and the corpus cavernous = unregulated blood entry + filling of corporea

22
Q

what are the clinical features of priapism?

A
  • Prolonged erection
  • Low flow – corpora cavernosa are rigid and tender, penis often painful
  • High flow – not painful
23
Q

how is priapism diagnosed?

A

Aspirate blood from corpus cavernosum – dark blood, low O2, high CO2 in low flow, normal arterial blood in high flow
Colour duplex – USS
o minimal or absent flow in cavernousal arteries in low flow
o normal to high flow in non-ischaemic priapism

24
Q

what is the management of ischaemic priaprism?

A

aspiration +/- irrigation with saline, injection of alpha agonist e.g. phenylephrine 100-200micrograms every 5-10 mins up to max
surgical shunt, >7 hrs unlikely to respond, penile prosthetic

25
Q

what is the management of non-ischaemic priaprism?

A

observe, respond spontaneously, selective arterial embolization

26
Q

what is Fournier’s gangrene?

A

necrotising fasciitis of penis

27
Q

what are the risk factors to Fournier’s gangrene?

A

diabetes, local trauma, periurethral extravasation, perianal infection

28
Q

where does Fournier’s gangrene arise from?

A

skin, urethra and rectal region

29
Q

what is the pathophysiology of Fournier’s gangrene?

A

Necrosis of superficial and deep fascial planes, fibrinoid coagulation of nutrient arterioles, polymorphonuclear cell infiltration

30
Q

what are the clinical features of Fournier’s Gangrene?

A

o Starts as cellulitis – swollen, red, tender, marked pain, fever, systemic toxicity
o Swelling + crepitus of scrotum, dark purple areas

31
Q

how is Fournier’s gangrene diagnosed?

A

plain Xray or USS

32
Q

how is Fournier’s gangrene managed?

A

antibiotics and surgical debridement

33
Q

what is balantis xerotica obliterans?

A

Pre-malignant Cutaneous Lesions

34
Q

what is the cause of balantis xerotica obliterans?

A

genetic, autoimmunity, infection, hormones, local skin changes

35
Q

what are the clinical features of balantis xerotica obliterans?

A

white patches, fissuring, scarring, bleeding, thin patches, itchy, fibrosis of tissue that prevents retraction

36
Q

where does balantis xerotica obliterans occur?

A

appears on foreskin and the glans penis

37
Q

what does a biopsy of balantis xerotica obliterans show?

A

thin epidermis, basal layer damage, pink

38
Q

what is the management of balantis xerotica obliterans?

A 
simple = circumcision,
complex = glans resurfacing
39
Q

what is the causes of a penile carcinoma in situ?

A

solar damage, arsenic, immunosuppression (AIDs), viral infection (PV), chronic skin injury

40
Q

what are the microscopic features of penile carcinoma in situ?

A

Atypical squamous cells proliferate through whole thickness of epidermis – entire tumour is confined to epidermis + doesn’t invade into dermis

41
Q

what are the types of penile carcinoma in situ?

A

o Erythroplasia of Querant = glans prepuce or shaft of penis

o Bowmen’s disease = remainder of genitalia

42
Q

how is penile carcinoma diagnosed?

A

biopsy

43
Q

what is the management of penile carcinoma in situ?

A

Excision/circumcision/glans resurfacing

Topic 5 fluorouracil/imiquod/laser

44
Q

what are the causes of penile squamous carcinoma?

A

Infection = HPV (also HIV and genital warts)
Hygiene + Injury circumcision
Others – age, tobacco, UV light

45
Q

how does penile squamous carcinoma grow?

A

o Grow laterally along surface and can cover entire glans, prepuce before invading the corpora and shaft of the penis
o Metastasis to femoral + inguinal nodes
o Originate at C15

46
Q

what are the clinical features of penile squamous carcinoma?

A

o Often delayed
o Red, raised area of penis
o Fungating mass = foul smelling
o Phimosis

47
Q

how are the different types of penile squamous carcinoma diagnosed?

A

o Primary – physical, histology/cytology, USS, MRI
o Regional – physical, histology/cytology, sentinel node biopsy
o Distant Metastases – pelvic CT, bone CT, chest Xray, bone scan
o Staging

48
Q

what is the management of penile squamous carcinoma?

A

Surgery – total/partial penectomy and reconstruction
Inguinal nodes – imaging, radionucleotide, sentienal node biopsy, inguinal lymphadectomy
Combined
 Radiotherapy – primary lesion, lymphnodes
 chemo – 5FY, cisplatin

Urology (10 decks)

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