Penile Urethral Disorders Flashcards
Urethritis
- what is this
- causes
- sx
- dx
- tx
What
-inflammation of the urethra
Cause
- gonorrhea
- chlamydia
- HPV
- Herpes simplex
- idiopathic
Sx Male -dysuria -itching/burning at meatus -hematuria/hematospermia -urethral discharge
Female
- frequency
- dysuria
- SP discomfort
- discharge
Dx
- UA/UC
- NAAT
Tx
- azithromycin
- Doxycycline
- treat patner, use condoms, NSAIDs
Urethral Stricture
- What is this
- types
- causes
- presentation
- dx
- tx
What: fibrotic band of tissue that renders the normal compliant urethral lumen inelastic. This narrows the urethra and slows the urine
Types
- Anterior: begins at the bulbar urethra and end at the meatus
- Posterior: involves the membranous and prostatic urethra
Causes
- Trauma (straddle injuries, penetrating injuries, urethral disruption from pelvic floor)
- Iatrogenic (catheterization/surgical)
- Infection (gonococcal/chlamydia)
Presentation
-obstructive urinary sx: slow stream, decreased caliber, post-void dribbling
Dx
- Catheter
- Cystoscopy
- RUG
Tx
- Urethral dilation
- DVIU (direct vision internal urethreotomy- you just go in with a scope and cut the scar open)
- Urethroplasty
Meatal Stenosis
- what
- causes
- sx
- dx
- tx
What
-narrowing of the opening of the urethra at the tip of the penis
Causes
- swelling and irritation after newborn circumcision
- idiopathic
Sx
- spraying of stream
- bed wetting
- dysuria
Dx
-physical exam
Tx
-meatonomy (put lidocaine on it, clamp it, cut it)
Hypospadius
- what
- presentation
- dx
- tx
What
-a congenital defect in which the opening of the urethra is on the underside of the penis
Presentation
- spraying of urine
- having to sit down to void
- foreskin makes the penis look like it has a hood
Dx
-made usually at time of birth with physical exam
Tx
- surgical repair
- -magpi
- -Snodgross (MC)
*can’t ever circumcise these kids because they need that skin if the ever get a repair
Balanitis
- what
- causes
- presentation
- PE findings
- Dx
- Tx
What
-inflammation of the glans penis
Causes
- infectious
- non-infectious (psoriasis)
Presentation
- pain
- irritation
- itching/burning
PE
- erythema/edema (red, beefy, scarring, ulcerations)
- discharge (magma:dead skin cells under foreskin)
- ulceration
Dx
- culture discharge
- wet mount
- potassium hydroxide
Tx
- Retraction of foreskin/ wash with soap and water
- bacitracin if bacterial infection suspected
- topical clotrimazole for candidal infection
- circumcision
Phimosis
- what
- causes
- complications
- presentation
- tx
What
-inability to retract the foreskin over the glans due to narrowing, constriction, or adhesions
Causes
- balanitis
- poor hygiene
Complcations
- balanitis
- paraphimosis
- voiding problems
- penile carcinoma
Presentation
- erythema
- ithching
- discharge
- pain with erection and incourse
Tx
- betamethasone cream 0.05% BID (to soften up scar enough to retract foreskin to clean everything)
- circumcision
Paraphimosis
- what
- can lead to?
- tx
What
-retracted foreskin becoming trapped proximal to the glans resulting in edema, inflammation, and pain (foreskin strangulated the head of the penis-this is an emergency)
Can lead to ischemia of the glans and eventual gangrene
Tx
- firm compression and manual reduction of the foreskin
- circumcision
Peyronie’s Disease
- what
- cause
- describe acute and chronic phases
- presentation
- tx
What
- curvature of the penis, particularly during erections
- fibrosis and plaque formation of the tunica albuginea
- MC in men 40-70 YO
Cause
- vascular trauma (micro trauma from sex)
- injury to the penis
Acute phase:
- includes penile pain, some curvature, penile nodule, and inflammation
- first 18-24 hours
Chronic phase:
-Stable plaque, penile angulation, and loss of erectile ability
Presentation
- penile pain
- penile angulation
- palpable plaque
- indentation in the shaft
- decreased erectile dysfunction
Tx
- if dx in first 6 months: vitamin E, ibuprofen, colchicine (anti-inflammatory)
- after 6 months with stable plaque: injection therapy or surgery
- -collagenase clostridiu histolyticum (Xiaflex): men with palpable plaque and at least a 30 degree curve
- -Verapamil: weekly injections for 6 weeks
Erectile Dysfunction
- what
- risk factors
- dx
What
-inability to achieve or maintain an erection for satisfactory sexual performance (this is common, 30% of 69YO and older have this)
Risk factors
- HTN
- sk=moking
- DM
- hyperlipidemia
- obesity
Dx
- international index of erectile function questionnaire
- fasting serum glucose
- lipid panel
- TSH
- testosterone level (this mainly just makes them feel better and be more active)
What is the most common sexual problem in men?
ED
Describe the pathophysiology of a normal erectile response
- initiated by parasympathetic and sympathetic neuronal triggers
- integrate physiologic stimuli
- Nitric oxide produced form endothelial cells after parasympathetic stimuli triggers smooth muscle relaxation and arterial influx of blood
- compression of venous return follows producing an erection (holds blood in penis)
ED
-tx
First line
- lifestyle modifications
- Meds
- -phosphodiesterase type 5 inhibitors:viagra, cialis, levitra, stendra
- *do not take with nitrates
Second line
- Alprostadil (Caverject)
- Vacuum pump device
- Muse (intraurethrally)
Third line
-inflatable penile prosthesis
