Penis and Foreskin Issues (Hypospadias, Ballanitis, Phimosis etc.) Flashcards
What is hypospadias?
Hypospadias is a congenital condition where the urethral meatus opens onto the ventral side of the penis which is proximal to the normal location in the glans penis. There is a dorsal hood because there is a deficiency in ventral foreskin. There can be a ventral bend in the penis known as the chordee.
How common is a hypospadias? Who gets hypospadias?
Occurs in 1/150 boys. Whites get it more. #damnstraight #blackpower
Why is a bad to have hypospadias?
Depending on the severity of the malformation it can lead to difficulty directing the urinary stream or in due course, infertility.
How do you manage this condition?
Surgical management is crucial and is performed between 6-12 months. Basically act early so that the child will retain normal adult sexual function and the child will not remember the surgery that he went through.
What is a smegma? Is it pathological?
Smegma deposits present as a firm, yellow-white mass beneath the prepuce in a non-retractile foreskin. It is non-pathological as it is basically the collection of peeling skin under the foreskin before separation of the foreskin has taken place. It can be confused with tumours and cysts but it is a normal variant and does not need to be treated.
What is ballanitis?
Ballanitis is when there is an infection under the foreskin with redness, inflammation, swelling and there sometimes can be a white exudate. Basically, the foreskin has separated and then a infection has started in the fold of skin between the foreskin and the penis. The causative organism is most likely e.coli.
How do you manage ballanitis?
Do NOT need oral ABx but need local antiseptic ointment beneath the foreskin. Ballanitis is just a superficial infection and will go away with this management if adhered to.
What is ballanitis xerotica obliterans?
Ballanitis Xerotica Obliterans (BXO) is basically a result of a chronic inflammatory reaction under the foreskin. This will present with swollen foreskin and scarring as a result of recurrent ballanitis. The management is to potentially make a dorsal slit in order to make the whole at the tip of the foreskin bigger.
What is phimosis?
Phimosis is when the opening at the tip of the foreskin is narrowed to a degree at which the foreskin cannot be retracted either physiologically or due to scarring (from BXO for example). It is important to distinguish between phimosis and physiological adherence of the foreskin to the glans. It causes urinary obstruction and ballooning of the foreskin on micturition.
Why is phimosis an emergency in some cases?
In some cases where the phimosis is blocking urethral outflow, the boy cannot urinate and must go into surgery today because he can go into renal failure via unriary retention and bladder distention. This can be observed if there is ballooning of the foreskin on micturition.
What is the management of a phimosis?
Mild cases of phimosis can respond to steroid ointment (betamethasone valerate) to the slight opening of the foreskin. More severe cases of phimosis need circumcision in order to prevent progression to urinary retention.
What is a paraphimosis?
Paraphimosis is a disorder of the foreskin when it is trying to separate from the glans. It presents as a red, swollen and painful penis. It is due to a mechanical problem when retracting the foreskin and it gets trapped behind the glans which will form a oedematous ring constricting the exposed and swollen glans penis.
In which population are you concerned of recurrent paraphimosis?
Developmentally delayed children.
In children who are developing normally, they will learn to not retract their foreskin in the same way. However, developmentally delayed children will not understand this and hence you worry about recurrent phimosis.
What is the management of a paraphimosis?
Management is gentle, firm external pressure which basically pushes blood out of the glans of the penis and then the glans can get through the constriction ring of the foreskin.
When is circumcision indicated and contraindicated?
Indicated: Phimosis and Recurrent Ballanitis
Contraindicated: Hypospadias (because they use the skin for penile reconstruction)
