PENIS!!!!!

Question 1

Balanitis/Posthitis Etiology –

Answer 1

typically monilial (yeast; usually in poorly controlled DM)

Question 2

Balanitis/Posthitis Work-up –

Answer 2

visual inspection;
HgbA1c,
STI testing

Question 3

Balanitis/Posthitis Treatment –

Answer 3

lotrimin +/- limited course of mild topical steroid; control DM; hygiene

Question 4

inability to retract foreskin

Answer 4

Phimosis

Question 5

Phimosis etiology

Answer 5

Physiologic: normal to age 4

Pathologic: usually feature of poor DM control in adult with monilial (yeast) posthitis; rarely traumatic

Question 6

Phimosis presentation

Answer 6

penile pain; fissuring of foreskin; deflection with erection; associated UTI; associated urinary retention

Question 7

Phimosis work up

Answer 7

good exam; urine C&S;
urinary residual;
HgbA1c

Question 8

Phimosis treatment

Answer 8

Child: expectant until age 4, then topical steroid
If refractory, refer for consideration of circumcision
Adult: Nystatin +/- topical steroid ( Mycolog)

Question 9

foreskin is stuck in retracted position, cannot be reduced

Answer 9

Paraphimosis

Question 10

Paraphimosis etiology

Answer 10

Iatrogenic – frequent feature of poor catheter care

Tight phimosis with retraction of prepuce

Question 11

Paraphimosis presentation

Answer 11

Edema, redness, pain
Glans can potentially be compromised
Need to ask patient, family, caregiver: “Circumcised?”

Question 12

Paraphimosis tx

Answer 12

Manual compression/reduction of edematous tissue
Dorsal slit (incise the foreskin in the OR)

Question 13

inflammation of the urethra

Answer 13

Urethritis

Question 14

Urethritis Etiology

Answer 14

STI (usually gonococcal, chlamydial)

Question 15

Urethritis Presentation

Answer 15

diffuse purulent d/c with dysuria

Question 16

Urethritis Work-up

Answer 16

urine probes, swabs

Question 17

Urethritis Treatment

Answer 17

treat as if for both G&C

Ceftriaxone/Cipro + Azithro/Doxy

Question 18

inability to obtain/maintain erection

Answer 18

Erectile Dysfunction (ED)

Question 19

Erectile Dysfunction (ED) etiology

Answer 19

Vasculogenic (poor arterial inflow; veno-occlusive etiologies), neurogenic, medication adverse effect (psychotropics, antihypertensives), hormonal, psychogenic

Question 20

Erectile Dysfunction (ED) risk factors

Answer 20

Up to 20% of patients with undiagnosed vascular disease will present with ED
DM, HTN, CAD, hyperlipidemia, smoking; surgery (radical prostatectomy); pelvic XRT

Question 21

Erectile Dysfunction (ED) made worse by

Answer 21

hormonal milieu (low testosterone)

Question 22

Erectile Dysfunction (ED) work up

Answer 22

Careful history (?maintain/attain; ?ejaculate; penile pain/curvature; ?partner satisfaction; ?stressors)
Blood pressure; genital exam
Total and free testosterone, fasting lipid panel

Question 23

Erectile Dysfunction (ED) tx

Answer 23

relax cavernosal smooth muscle

Pills – PDE inhibitors (Viagra, Levitra, Cialis)
Injectable PGE1 (Caverject)
Penile PGE1 suppository (MUSE)
Vacuum erectile device
Surgery (prosthetics – rigid or inflatable)

Question 24

penili wartz =

Answer 24

Penile Condyloma

Question 25

Penile Condyloma etiology

Answer 25

HPV-related

Question 26

Penile Condyloma presentation

Answer 26

bulky, solitary/multiple Can be superinfected Check anus (may i check your anus please)

Question 27

Penile Condyloma diagnosis

Answer 27

largely clinical | Biopsy if atypical features (large, pigmentation, induration), refractory to treatment, immunocompromised, etc.

Question 28

Penile Condyloma tx

Answer 28

Lesions: Chemical/physical destruction: podofilox, cryotherapy Immuno: Veregen, imiquimod (cytokine induction) Surgical excision, laser ablation (CO2, Holmium) Counseling: chronicity of the disease (no cure), partner notification, condoms can decrease (but not eliminate) risk, can be associated with other STIs

Question 29

Penile Cancer epidemiology

Answer 29

rare

Question 30

Penile Cancer etiology

Answer 30

Associated HPV (16, 18, 31, 33), rare in circumcised men, it’s a skin cancer (squamous)

Question 31

Penile Cancer presentation

Answer 31

Condylomata, penile swelling, balanitis, phimosis

Question 32

Penile Cancer tx

Answer 32

surgical Circumcision, partial penectomy, radical penectomy with urinary diversion (perineal urethrostomy) and lymph node dissection

Question 33

Penile Cancer prognosis

Answer 33

stage-dependent

Question 34

Penile Cancer prevention

Answer 34

?circumcision ; HPV vaccine

Question 35

Urethral Strictures

Answer 35

Congenital | Iatrogenic

Question 36

Urethral Strictures tx

Answer 36

Dilation Internal urethrotomy Urethroplasty

Question 37

Priapism cause and tx

Answer 37

Idiopathic Systemic disease Trauma Medications