Phimosis, prostatitis

Question 1

Define/cause of phimosis?

Answer 1

Foreskin is too tight to be retracted over the glans of the penis.

Common in infants and young children, resolves overtime.

Adults -suspect underlying condition, e.g.:
STI
Eczema
Psoriasis
Lichen planus
Lichen sclerosis
Balanitis

Question 2

Presentation of phimosis?

Answer 2

Inability to retract the foreskin.

May interfere with urination (dribbling, weak stream) or sexual function (pain during sex and erection).

Question 3

Diagnosis/IVx of phimosis?

Answer 3

Clinical diagnosis

US or uroflowmetry may be used if uncertain or if complications are suspected.

Question 4

Management of phimosis?

Answer 4

Topical steroids (reduce inflammation and encourage stretching of the foreskin)

Circumcision may be considered in recurrent or refractory cases.

Question 5

Define/cause of prostatitis?

Answer 5

Inflammation and/or infection of the prostate gland.

Can be acute or chronic (>3wks).

Bacterial infection e.g. E.coli.

RFs:
UTI
Epididymitis
Catheter use
Previous urethral surgery
Presence of prostate stones

Question 6

Presentation of prostatitis?

Answer 6

Perineal or prostatic pain
Lower UTI symptoms (dysuria, frequency, urgency)
Fever, myalgia
Boggy prostate on DRE

Question 7

Diagnosis/IVx of prostatitis?

Answer 7

DRE -tender, warm, swollen prostate

Midstream sample of urine for culture and sensitivity

Screen for STI (gonorrhoea can cause prostatitis)

Question 8

Management of prostatitis?

Answer 8

Abx (quinolones for 14days)
Analgesia
Urinary retention -catheterisation