penis problems

Question 1

signs the cause for an erectile dysfunction is organic

Answer 1

normal libido and gradual onset

Question 2

organic causes for erectile dysfunction

Answer 2

thyroid, vascular (atherosclerosis!!), hyperprolactinaemia

Question 3

investigations for erectile dysfunction

Answer 3

always do a QRISK, look at HbA1c and lipid profile, free testosterone

Question 4

Mx of ED

Answer 4

PDE-5 inhibitor (sildenafil) which can be brought over the counter or can be prescribed to everyone regardless of their cause of ED

Question 5

SE of sildenafil

Answer 5

headache, flushing, dizziness

Question 6

when should ED be referred to urology

Answer 6

if a young man and always had a problem with erection

Question 7

benefits of circumcision

Answer 7

lower UTI, lower STI, reduced risk of penile cancer

Question 8

medical indications for circumcision

Answer 8

paraphimosis, phimosis and recurrent balanitis

Question 9

what is the difference between phimosis and paraphimosis

Answer 9

phimosis is a tight foreskin (gives rise to painful erections) and paraphimosis is the inability to return the retracted foreskin causing vascular compromise

Question 10

causes for phimosis

Answer 10

physiological (normally resolves be age 5) or pathological (due to scarring, infection, inflammation such as BXO)

Question 11

what is balanitis

Answer 11

inflammation of the glans of the penis

Question 12

v common causes of balanitis

Answer 12

candidiasis, contact dermatitis, eczema

Question 13

other causes of balanitis

Answer 13

bacterial infections (staph), balanitis xerotica obliteran (male version of lichen sclerosis) or circinate balanitis (skin erosions you get in reactive arthritis

Question 14

MX of balanitis

Answer 14

-normally clinical diagnosis, may do swabs if infective cause
1) hygiene –> wash properly under the foreskin using saline and can use 1% hydrocortisone
2) treat any underlying cause

Question 15

what is priapism

Answer 15

sustained and unwanted erection normally for >4hrs

Question 16

causes of priapsim

Answer 16

idiopathic, SCD, PDE-5 inhib, trauma

Question 16

what are the two causes of priapism

Answer 16

ischaemic (trapping of deoxygenated blood) and non ischaemia (where there is a high arterial inflow)

Question 20

Ix for priapism

Answer 20

a clinical diagnosis but do a carvernosal blood analysis to see if ischaemic or not

Question 21

MX of priapism

Answer 21

1) if ischaemic is is a medical emergency and need to be treated straight away else can get long term erectile dysfunction - do this by aspiration of blood from cavernosa
2) if this doesn’t work can inject vasoconstrictive agents