Penis

Question 1

Action of testosterone and DHT antenatal

Answer 1

Testosterone stimulate wolffian ducts male ductal system
Action of DHT stimulates male external genitalia and prostate
MIH from Sertoli cells first stage of testicular descent by action on gubernaculum to anchor to region of future inguinal canal
Second phase testicular descent due to testosterone stimulation in week 25-30, causes gubernaculum to retract guide testis through inguinal canal

Question 2

megaprepuce pathology

urination problems

Answer 2

enormously capacious preputial sac, engulfing the whole penile shaft and upper scrotum (prompting the term ‘preputial bladder’)

Urine dribbles more or less continuously from the preputial orifice and, although the capacious urine-filled sac can be readily emptied by compression, there is never a normal urinary stream.

Question 3

complications circumcision

Answer 3

Bleeding requiring re-operation 1-2%
Urinary retention – sit boy in warm bath allow to urinate in water
Most common is encrustation scabbing and infection of explosed glans
Meatal stenosis 0-11%
Infection requiring abx 2%
Dissatisfaction cosmetic result 4%
BXO affecting glans external meatus or urethra in the future

Question 4

megaprepuce treatment

Answer 4

reconstruction of foreskin

Question 5

histology lichen sclerosis

Answer 5

Loss of rete pegs
Hyperkeratosis
Thinned epithelium
including an acellular band/layer between the epithelium and deeper dermis and a band-like chronic inflammatory cell infiltrate

Question 6

risk penile cancer LS

Answer 6

Phimosis OR 11-16 vs no phimosis

Question 7

progression LS to penile cancer

Answer 7

5%

Question 8

baus complications circumcision 8

Answer 8

almost all
swelling penis few days
increased sensitivity
permenant reduced altered sensation glans

1/50-1/100
infection incision drainage abx
bleeding

1/50 to 1/250
dissatisfaction cosmetic result
oedema excess swelling skin
anaesthetic risk

meatal stenosis 0-11%