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UROLOGY > PENILE & URETHRAL DISORDERS > Flashcards

PENILE & URETHRAL DISORDERS Flashcards

1
Q

Two columns of tissue that run along side the penis that helps with erections

A

CORPUS CAVERNOSUM

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2
Q

⦁ Column of sponge-like tissue that runs along the front and ends at the glans
⦁ The urethra runs through here

A

CORPUS SPONGIOSUM

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3
Q

Runs through the spongiosum and helps evacuate semen and urine from the body

A

URETHRA

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4
Q

urethritis is more common in __________

A

females

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5
Q

CAUSES OF URETHRITIS

A 
⦁	Gonorrhea
⦁	Chlamydia
⦁	HPV
⦁	Herpes Simplex
⦁	Idiopathic
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6
Q

most common causes of urethritis

A

⦁ Gonorrhea

⦁ Chlamydia

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7
Q

male symptoms of urethritis

A

⦁ dysuria
⦁ itching or burning at the meatus
⦁ hematuria / hematospermia
⦁ urethral discharge

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8
Q

female symptoms of urethritis

A

⦁ dysuria
⦁ frequency
⦁ suprapubic discomfort
⦁ discharge

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9
Q

DIAGNOSIS OF URETHRITIS

A

UA & CULTURE

NAAT (for chlamydia & gonorrhea)

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10
Q

TREATMENT OF URETHRITIS

A

Suspected gonococcal vs non-gonococcal.
intramuscular dose of ceftriaxone(250 mg)
Azithromycin 1g PO single dose
Doxycycline 100mg bid x 7 days
Alternatives
Erythromycin 500mg PO qid x 7 days
Levofloxacin/Cipro 500mg PO once daily x 7 days

So Rocephin for gonococcal
Azithro or Doxy for non-gonococcal

fluoroquinolones are coming out of favor though due to resistance

  • Treat partner
  • Educate about condom use
  • Avoid irritants
  • NSAIDS

***Bring pt back to re-test to assure pt is cured

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11
Q

A fibrotic band of tissue that renders the normal compliant urethral lumen inelastic

A

URETHRAL STRICTURE

Narrowing of the urethra with slowing of the urine

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12
Q

2 types of urethral strictures

A

anterior & posterior

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13
Q

anterior urethral stricture = from _______ to ______

A

from bulbar urethra to the meatus (from below the prostate to tip of penis)

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14
Q

posterior urethral stricture =

A

membranous & prostatic urethra (from bladder to prostate)

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15
Q

most common cause of urethral stricture in developed countries

A

idiopathic

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16
Q

causes of urethral stricture

A

o Idiopathic = most common cause of urethral stricture in developed countries

o Trauma
⦁ Anterior urethra = straddle injuries, blunt trauma, penetrating injuries
⦁ Posterior urethra = urethral disruption from pelvic fracture

o Iatrogenic
⦁ Catheterization - wrong size / traumatic
⦁ Surgical

o Infection
⦁ Gonococcal / Chlamydia (urethritis)

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17
Q

traumatic causes of anterior urethral stricture

A

saddle injuries, blunt trauma, penetrating injuries

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18
Q

traumatic causes of posterior urethral stricture

A

urethral disruption from pelvic fracture

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19
Q

iatrogenic causes of urethral stricture

A

cath - wrong size / traumatic

surgery

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20
Q

infectious causes off urethral stricture

A

gonococcal / chlamydia (urethritis)

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21
Q

SYMPTOMS OF URETHRAL STRICTURE

A

⦁ slow stream
⦁ decreased caliber
⦁ post-void dribbling

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22
Q

DIAGNOSIS OF URETHRAL STRICTURE

A
  • Uroflowmetry = cylindrical device that measures speed of urination
  • Ultrasound PVR
  • Catheter
  • Cystoscopy
  • RUG - Retrograde Urethrogram = inject dye to see path/look for obstruction to bladder
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23
Q

cylindrical device that measures speed of urination

A

uroflowmetry

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24
Q

initial diagnostic test for urethral stricture

A

US PVR

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25
Q

urethral stricture treatment

A
  • urethral dilation
  • DVIU
  • urethroplasty

⦁ urethral dilation (with calibers - insert larger & larger calibers through urethra - pt will need to continue with self-calibration)

⦁ DVIU = direct vision internal urethrotomy - use camera through urethra and carve out tissue in urethra

⦁ Urethroplasty = re-direct urethra to perineum - now has to sit down to pee as urethra is no longer coming out of penis. Increased risk of infection due to proximity to anus. This is the permanent long-term fix for urethral stricture

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26
Q

Narrowing of the opening of the urethra at the tip of the penis

A

MEATAL STENOSIS

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27
Q

CAUSES OF MEATAL STENOSIS

A

⦁ swelling & irritation after newborn circumcision
⦁ idiopathic
⦁ failed “spadias” repairs

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28
Q

SYMPTOMS OF MEATAL STENOSIS

A

⦁ spraying of stream
⦁ bed wetting
⦁ dysuria

⦁ spraying of stream** (narrowing at meatal opening but not at the rest of the urethra, so pressure ends up spraying everywhere

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29
Q

***SPRAYING OF URINE

A

meatal stenosis

also hypospadias

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30
Q

DIAGNOSIS OF MEATAL STENOSIS

A

PHYSICAL EXAM

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31
Q

TREATMENT OF MEATAL STENOSIS

A

MEATONOMY

subincision underneath the glans

A meatotomy is a form of penile modification in which the underside of the glans is split

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32
Q

bed wetting

A

meatal stenosis

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33
Q

A congenital defect in which the opening of the urethra is on the underside of the penis

A

hypospadias

34
Q

Hypospadias can occur anywhere between the _____ and the ___________________

A

glans and penile-scrotal junction

35
Q

presentation of hypospadias

A

Spraying of urine
Having to sit down to void
Foreskin makes the penis look like it has a “hood”
Urinary retention

36
Q

locations of hypospadias

A 
o Glanular
	o Subcoronal
	o Mid shaft
	o Penoscrotal (junction)
	o Midscrotal
	o Perineal
37
Q

diagnosis of hypospadias

A

made usually at the time of birth with physical exam

38
Q

treatment of hypospadias

A

surgical repair (4-18 months)

39
Q

when is surgical repair for hypospadias done

A

4-18 months

40
Q

surgical repairs for hypospadias

A

⦁ Magpi = for glanular hypospadias - consists of meatonomy & glanuloplasty

⦁ Snodgrass = can be used for both distal hypospadias as well as more proximal ones
o complications = meatal stenosis & fistula

41
Q

complications of Snodgrass repair (for hypospadias)

A

meatal stenosis

fistula

42
Q

inflammation of the glans penis

43
Q

who is most affected by balanitis

A

uncircumcised men with poor hygiene

44
Q

causes of balanitis

A

o infectious
o non-infectious
- drug-induced eruptions
- derm-related (Behcets)

45
Q

presentation of balanitis

A

⦁ pain
⦁ irritation
⦁ itching / burning

46
Q

PHYSICAL EXAM OF BALANITIS

A

⦁ erythema / edema
⦁ discharge
⦁ ulceration

47
Q

DIAGNOSIS OF BALANITIS

A

⦁ culture discharge
⦁ wet mount
⦁ potassium hydroxide (KOH) - check for yeast infxn

48
Q

TREATMENT OF BALANITIS

A

⦁ retraction of foreskin / wash with soap and water
⦁ Bacitracin if suspect bacterial
⦁ Clotrimazole if candida infxn
⦁ Circumcision

49
Q

The inability to retract the foreskin over the glans due to narrowing, constriction or adhesions

50
Q

in children, phimosis may _______________

A

resolve on its own

51
Q

CAUSES OF PHIMOSIS

A

⦁ balanitis (infection/inflammation causes adhesions)

⦁ poor hygiene

52
Q

complications of phimosis

A

⦁ balanitis
⦁ paraphimosis (finally get foreskin retracted, then can’t get it back up)
⦁ voiding problems (dribbling)
⦁ penile carcinoma

53
Q

PRESENTATION OF PHIMOSIS

A

⦁ erythema
⦁ itching
⦁ discharge
⦁ pain with erection & intercourse

54
Q

TREATMENT FOR PHIMOSIS

A

⦁ Betamethasone cream 0.05% BID - helps to soften the skin/break down adhesions
⦁ Circumcision

55
Q

The retracted foreskin becomes trapped proximal to the glans

A

paraphimosis

56
Q

in paraphimosis, The retracted foreskin becomes trapped proximal to the glans, leading to

A

edema
inflammation
pain

57
Q

UNTREATED PARAPHIMOSIS CAN LEAD TO

A

ischemia of the glans and eventual gangrene

58
Q

treatment of paraphimosis

A

⦁ Firm compression & manual reduction of the foreskin

⦁ Circumcision

59
Q

Curvature of the penis, particularly during erections

A

Peyronie’s Disease

60
Q

fibrosis & plaque formation of tunica albuginea

A

Peyronie’s Disease

61
Q

Causes of Peyronie’s Dz

A

⦁ vascular trauma

⦁ injury to the penis

62
Q

usual age of Peyronie’s dz

63
Q

acute phase of Peyronie’s dz

A

first 18-24 hours

includes penile pain, some curvature, penile nodule and inflammation

64
Q

chronic phase of Peyronie’s dz

A

characterized by stable plaques, penile angulation and loss of erectile ability

65
Q

presentation of Peyronie’s dz

A 
⦁	penile pain
⦁	penile angulation
⦁	palpable plaque
⦁	indentation in the shaft
⦁	increased ED**
66
Q

TREATMENT FOR PEYRONIE’S DISEASE

A
  • if diagnosed in the first 6 months
    ⦁ vitamin E
    ⦁ ibuprofen
    ⦁ colchicine = (gout medication) - inhibits collagen formation - inhibits plaque formation and can actually help reduce plaques in some pts
  • after 6 months - have a stable plaque
    ⦁ Injection therapy
    • Collagenase clostridium histolyticum (Xiaflex) - for men with a palpable plaque and at least 30 degree curvature
    • Verapamil (CCB) = weekly injections x 6 weeks
      ⦁ Surgery
67
Q

TREATMENT FOR PEYRONIE’S DZ IF IN FIRST 6 MONTHS

A

⦁ vitamin E
⦁ ibuprofen
⦁ colchicine = (gout medication) - inhibits collagen formation - inhibits plaque formation and can actually help reduce plaques in some pts

68
Q

TREATMENT FOR PEYRONIE’S DZ AFTER 6 MONTHS

A
  • after 6 months - have a stable plaque

⦁ Injection therapy

- Collagenase clostridium histolyticum (Xiaflex) - for men with a palpable plaque and at least 30 degree curvature
- Verapamil (CCB) = weekly injections x 6 weeks

⦁ Surgery

69
Q
  • the inability to achieve or maintain an erection for satisfactory sexual performance
70
Q
  • The most common sexual problem in men
71
Q

PATHOPHYS OF AN ERECTION

A
  • interaction between neurotransmitters, biochemicals, and a smooth muscle response
  • initiated by parasympathetic & sympathetic neuronal triggers
  • integration of physiologic stimuli of the penis & sexual perception/desire
  • Nitric oxide = produced from endothelial cells after parasympathetic stimuli triggers smooth muscle relaxation and arterial influx of blood
  • compression of venous return follows –> produces an erection
72
Q

______________ triggers smooth muscle relaxation and arterial influx of blood

A

nitric oxide

73
Q

nitric oxide is produced from

A

endothelial cells after parasympathetic stimuli

the nitric oxide released is then what triggers smooth muscle relaxation & arterial influx of blood

74
Q

risk factors for ED

A 
⦁	HTN
⦁	smoking
⦁	DM
⦁	hyperlipidemia
⦁	obesity
75
Q

DIAGNOSIS OF ED

A 
⦁	International Index of Erectile Function Questionnaire
⦁	fasting serum glucose
⦁	lipid panel
⦁	TSH
⦁	testosterone level
76
Q

Do NOT take PDE5-inhibitors with

77
Q

1ST LINE TX FOR ED

A

lifestyle modifications

PDE-5 inhibitors (phosphodiesterase 5-inhibitors)

Sildenafil/Viagra
Tadalafil/Cialis
Vardenafil/Levitra
Avanafil/Stendra

78
Q

SE of PDE-5 inhibitors

A

HA
flushing
rhinitis
abnormal vision

79
Q

2nd line tx for ED

A

⦁ Alprostadil (Caverject) - vasoactive substance injected into corpus cavernosum
⦁ Vacuum pump devise
⦁ Muse intraurethrally - like a urethral suppository - injected into urethra

80
Q

3rd line tx for ED

A

⦁ inflatable penile prosthesis

UROLOGY (12 decks)

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