Penile & Urethral Disorders Flashcards
Disorders of the Urethra
Urethritis
Urethral stricture
Meatal stenosis
Hypospadius
Define Urethritis
Inflammation of the urethra
Causes of Urethritis
Gonorrhea Chlamydia HPV Herpes simplex Idiopathic
Symptoms of Urethritis in Males
Dysuria
Itching or burning at the meatus
Hematuria/hematospermia
Urethral discharge
Symptoms of Urethritis in Females
Frequency
Dysuria
Suprapubic discomfort
Discharge
Diagnostics of Urethritis
UA & culture
NAATs
Treatment of Urethritis
Azithromycin
Doxycycline
Alternatives: erythromycin, levofloxacin/cipro
Treat partner
Use condoms
Avoid irritants: caffeine, citric juices, tomatoes
NSAIDs
Define Urethral Stricture
Narrowing of the urethra with slowing of the urine
Two Types of Urethral Stricture
Anterior: begins at the bulbar urethra & end at the meatus
Posterior: involves the membranous & prostatic urethra
Etiology of a Urethral Stricture
Trauma
Iatrogenic
Infection
Trauma Etiology of Anterior Urethral Stricture
Straddle injuries
Penetrating injuries
Trauma Etiology of Posterior Urethra
Urethral disruption from pelvic fracture
Iatrogenic Etiology of Urethral Stricture
Catheterization
Surgical
Infectious Etiology of Urethral Stricture
Gonococcal
Chlamydia
Presentation of Urethral Strictures
Slow stream
Decreased caliber
Post-void dribbling
Diagnosis of Urethral Strictures
Catheter
Cystoscopy
Retrograde urethrogram (RUG)
Treatment of Urethral Stricture
Urethral dilation
Direct vision intra-uthrotomy (DVIU)
Urethroplasty
Define Meatal Stenosis
Narrowing of the opening of the urethra at the tip of the penis
Causes of Meatal Stenosis
Swelling & irritation after newborn circumcision
Idiopathy
Symptoms of Meatal Stenosis
Spraying of stream
Bed wetting
Dysuria
Diagnosis of Meatal Stenosis
Physical exam
Treatment of Meatal Stenosis
Meatonomy
Define Hypospadius
Congenital defect in which the opening of the urethra is on the underside of the penis
Presentation of Hypospadius
Spraying of urine
Having to sit down to void
Foreskin makes the penis look like it has a “hood”
Diagnosis of Hypospadius
Made at the time of birth with PE
Treatment of Hypospadius
Surgical repair (4-18 months)
Complications of Surgical Repair of a Hypospadius
Meatal stenosis
Fistula
Penile Disorders
Balanitis Phimosis Paraphimosis Peyronie's Disease Erectile Dysfunction
Define Balanitis
Inflammation of the glans penis
Uncircumcised men with poor hygiene most affected
Causes of Balanitis
Infectious: candida, chlamydia, pseudomonas, gonorrhea
Non-infectious: balanitis xerotica obliterans
Presentation of Balanitis
Pain
Irritation
Itching/Burning
PE Findings for Balanitis
Erythema/Edema
Discharge
Ulceration
Diagnosis of Balanitis
Culture discharge
Wet mount
Potassium hydroxide
Treatment of Balanitis
Retraction of foreskin/wash with soap & water
Bacitracin if bacterial infection suspected
Topical clotrimazole for candidal infection
Circumcision
Define Phimosis
Inability to retract the foreskin over the glans due to narrowing constriction, or adhesions
Causes of Phimosis
Balanitis
Poor hygiene
Complications of Phimosis
Balanitis
Paraphimosis
Voiding problems
Penile carcinoma
Presentation of Phimosis
Erythema
Itching
Discharge
Pain with erection & intercourse
Treatment of Phimosis
Betamethasone cream 0.05% BID
Circumcision
Define Paraphimosis
Retracted foreskin becoming trapped proximal to the glans resulting in edema, inflammation, and pain
Treatment of Paraphimosis
Firm compression & manual reduction of the foreskin
Circumcision
Define Peyronie’s Disease
Curvature of the penis, particularly during erections
Fibrosis & plaque formation of the tunica albuginea
Causes of Peyronie’s Disease
Vascular trauma
Injury to the penis
Acute Phase of Peyronie’s Disease
First 18-24 hours
Includes penile pain, some curvature, penile nodule, & inflammation
Chronic Phase of Peyronie’s Disease
Characterized by stable plaque, penile angulation, & loss of erectile ability
Presentation of Peyronie’s Disease
Penile pain Penile angulation palpable plaque Indentation in the shaft Decreased erectile dysfunction
Treatment of Peyronie’s Disease if Diagnosed in the First 6 Months
Vitamin E
Ibuprofen
Colchicine
Treatment of Peyronie’s Disease if Diagnosed After 6 Months with a Stable Plaque
Injection therapy
Surgery
Injection Therapy for Peyronie’s Disease
Collagenase clostridiu histoyticum (Xiaflex)
Verapamil: breaks up scar tissue
Define Erectile Dysfunction
Inability to achieve or maintain an erection for satisfactory sexual performance
Risk Factors for Erectile Dysfunctino
HTN Smoking DM Hyperlipidemia Obesity Surgery: prostatectomy, lymph node dissection Meds: SSRIs, beta-blockers
Diagnosis of Erectile Dysfunction
International index of erectile function questionnaire Fasting glucose Lipid panel TSH Testosterone level
Treatment of Erectile Dysfunction
1st: lifestyle modifications
1st-line medications: phosphodiesterase type 5 inhibitors
2nd-line medications: alprostadil (Caverject), vacuum pump device, Muse intraurethrally
3rd-line: inflatable penile prosthesis
Phosphodiesterase type 5 (PDE5) Inhibitors for Erectile Dysfunction
Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)
Avanafil (Stendra)
SE of Phosphodiesterase Type 5 (PDE5) Inhibitors
Headache
Flushing
Rhinitis
Abnormal vision
