Penis Flashcards
Identify picture 2
Pearly penile papules
What are pearly penile papules
Benign papules on corona of glans. Due to uncircumcision
Often confused with condyloma acuminata
Identify picture 3
Prince Albert ring
Complication of Prince Albert ring
Urethral fistula
Why do people get Prince Albert ring
Increases sexual pleasure
Define priapism
Painful, prolonged (>6h) erection unaccompanied by sexual desire
Define Peyronie’s disease
Fibrous plaque involving tunica albuginea of penis causing penile pain on erection, chordee usually dorsal, erectile dysfunction.
Etiology of Peyronie’s disease
Repetitive microvascular trauma due to coitus (wound healing disorder causing prolonged inflammation and remodelling)
Clinical features Peyronie’s disease? (5)
- Penile pain when erect
- Penile curvature (chordee) usually dorsal (inelastic plaque restricts expansion )
- loss of erections in late stage. (Interfere with veno-occlusive mechanism)
- palpable plaque usually on dorsum, mid-shaft or distal penis.
- later: penile shortening, narrowing, hourglass deformity.
Risk factors Peyronie’s disease? (5)
• Middle aged 40-60 • connective tissue disorder (20% have associated Dupuytren's contracture)! • diabetes • post radical prostatectomy . Hypertension • hypogonadism • smoking • familial predisposition, vascular disease
Treatment Peyronie’s disease? (4)
• 50% resolve spontaneously within a year.
• penile pain: vitamin E and colchicine ( gout medication), NSAIDs orally or intralesional injection with verapamil (ccb), collagenase or interferon. None of these very successful.
• penile curvature: surgery if unable to have intercourse and disease stabilised.
- Nesbit procedure (plication) ( disadvantage penile shortening) (most common)
- excision of plaque (complex)
- shock therapy
• loss erections: medications like pde5 inhibitors unsatisfactory, need penile implant if loss function .
What is BXO?
Balanitis xerotica obliterates, or lichen sclerosis et atrophicus
pre-malignant white patch on glans and penis from chronic infection, phimosis
Treatment penile leukoplakia?
Local excision
Treatment condyloma acuminatum?
• Podophyllin
. Fulgaration (diathermy)
• cryotherapy
What is bowenoid papulosis
- Rare, sexually transmitted disorder caused by HPV 16.
- resemble cis
- many papules or flat granular lesions, reddish brown or violet, solid, velvety
What is condyloma acuminatum
• Genital wants caused by HpV 16 and 18.
• pre-malignant, associated with SCC of penis
- soft, multiple lesions on glans, prepuce and shaft.
Treatment of penile cancer (primary lesion and lymph nodes)? (6)
• Primary lesion: surgical under antibiotic cover
Confined to foreskin: circumcision
- glans or distal shaft: partial penectomy
- proximal shaft; total penectomy and perineal urethrostomy
- small lesions: radiotherapy (external beam or brachytherapy ) (low chance lymph involve)
•lymph nodes:
- radical inguinal node dissection only if malignant nodes confirmed on aspiration cytology (high complication rate)
- Rest of cases bilateral modified inguinal node dissections
- Inoperable inguinal nodes (fixed or ulcerated) must be treated to avoid ulceration and haemorrhage: initial chemo → salvage surgery (best) or radiotherapy
What is the factor associated with the worst prognosis in penile cancer?
Iliac lymph node involvement. No chance of 5 year survival.
Define erectile dysfunction
Consistent, > 3 months, or recurrent inability to obtain or maintain an adequate erection sufficient for penetration and successful intercourse
Describe the normal physiology and steps of an erection (6)
1 psychogenic erections mediated by central erection centres ;
reflexogenic by genital stimulation mediated peripherally by spinal cord erection centres: s2-s4 parasympathetic ( Point );
Nocturnal erections during REM sleep mediated by central
(somatic : dorsal penile, cavernous and pudendal nerves must be intact too)
- Nitric oxide released in corpora cavernosa from NANC neurons and endothelium
- NO activate guanylate cyclase → increased cyclic guanosine monophosphate (CGMP ) from GTP → sinuosidal smooth muscle relaxation
4 increased blood flow to penis: iliac arteries → internal pudendal → cavernous → helicine arteries of penis
- Increased intracavernosal pressure causing venous obstruction to maintain erection
- normal hormone environment (testosterone, prolactin and thyroid) is necessary.
Describe the normal physiology and steps of an ejaculation (4)
- Sensory afferents from glans
- secretions from prostate , seminal vesicles and ejaculatory ducts enter prostatic urethra (sympathetic T10/11- L2 )
- bladder neck closure (sympathetic)
- spasmodic contraction of bulbocavernosus and pelvic floor muscles (somatic)
