Problems of the penis Flashcards
Congenital problems
Hypospadias
- Urethral meatus is on the ventral surface of penis anywhere from corona to perineum
- Cuases: hormonal influences in utero, environmental factors, and genetic factors
- Treatment = surgical repair
- *****chordee = painful downward curvature during erection
- **Prevention on urination or intercourse
- ***** cosmetic reasons or emotional well being
Probs of foreskin: phimosis
less in US bc of circumcision
Phimosis = tightness or constriction around head of penis
- unable to retract foreskin due to chronic inflammation from poor hygiene
- Treatments:
- —topical corticosteroid cream (may have antifungal)
- —circumcision
- –dorsal slit surgery
Probs of foreskin: paraphimosis
Tightness of retracted foreskin; unable to put back over glans
-retracted during bathing, urinary catheteration, or intercourse and not put back
Urologic emergency; compromised arterial bloodflow to glans –> ulcer may develop
Goal of treatment: manually reduce foreskin to natural position; ice or hand compression
-circumcision or dorsal slit surgery
Erectile problems: priapism
Priapism = painful erection for over 4 hrs
- medical emergency due to obstructed venous outflow
- —associated condidions: sickle cell disease, diabetes, spinal cord trauma, degenerative spinal lesions, drugs
- — vasoactive drugs injected into corpora cavernosa for ED
-complications = penile tissue necrosis or hydronephrosis
Priapism treatments
depend on cause
Sickle cell = blood exchange transfusion
Others:
- sedatives
- smooth muscle relaxant injected into penis
- aspiration and irrigation of corpora cavernosa
Erectile problems: peronie’s disease
Plaque formation in one of the corpora cavernosa of the penis results in inelasticity and curvature during erection
- may occur spntaneously or due to trauma
- may be painful or embarrassing but not dangerous
Therapy:
- collagenase clostridium histolyticum (Xiaflex) and intralesion verapamil (ILV) injections
- surgery
Cancer of penis
Rare in US; 95% squamous cell carcinoma
Most common with HPV, phimosis, or uncircumcised men
Tumor appears as superficial ulceration or pimple-like nodule; pain is rare and leads to delayed treatment
Treatment (early stage) = laser removal
- if spread - radical resection
- surgery radiation or chemo depending on extent of cancer, lymph node involvement, or metastasis
Testicular cancer etiology and pathophysiology
Rare –> less than 1% of male cancers
Most common cancer in males ages 15 to 44; median age is 33
8430 new cases per yr
More common with cryptorchidism (testis doesn’t fall) or fam history or anomalies
Where does testicular cancer develop from?
2 types of embryonic germ cells:
- seminoma = most common but least aggressive
- nonseminomas = rare but aggressive
non-germ cell tumors come from other testicular tissue (leydig cell or sertoli cell tumors) –> less than 10%
Testicular cancer manifestations
-slow or rapid onset depending on tumor type
Painless lump in scrotum- scrotal swelling and heavy feeling
scrotal mass - nontender and firm
Dull ache or heaviness in lower abdomen, perianal area, or scrotum
acute pain - first symptoms in 10% patients
Advanced disease - lower back or chest pain, cough, and dyspnea
Diagnostic studies for testicular cancer
palpation of scrotum
ultrasound
Serum tumor markers if cancer suspected
-AFP, LDH, hCG
biopsy
Chest xray, CBC, BMP, and LFTs
CT scan of abdomen and pelvis
-staging and assess for metastasis
