Problems of the penis

Question 1

Congenital problems

Answer 1

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

Question 2

Probs of foreskin: phimosis

Answer 2

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

Question 3

Probs of foreskin: paraphimosis

Answer 3

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

Question 4

Erectile problems: priapism

Answer 4

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

Question 5

Priapism treatments

Answer 5

depend on cause

Sickle cell = blood exchange transfusion

Others:

• sedatives
• smooth muscle relaxant injected into penis
• aspiration and irrigation of corpora cavernosa

Question 6

Erectile problems: peronie’s disease

Answer 6

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

Question 7

Cancer of penis

Answer 7

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

Question 8

Testicular cancer etiology and pathophysiology

Answer 8

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

Question 9

Where does testicular cancer develop from?

Answer 9

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%

Question 10

Testicular cancer manifestations

Answer 10

-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

Question 11

Diagnostic studies for testicular cancer

Answer 11

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