The Dick

Question 1

Balanitis:

Answer 1

Inflammation of glans penis

Question 2

Posthitis:

Answer 2

inflammation of penile foreskin

Question 3

Balanitis/Posthitis etiology

Answer 3

typically monilial (yeast; usually in poorly controlled DM)

Question 4

Balanitis/Posthitis presentation:

Answer 4

glossy flat lesions of penis/foreskin; blotchy erythema; penile adhesions; smegma; phimosis
-usually can’t retract foreskin so don’t try!!!

Question 5

Balanitis/Posthitis work-up:

Answer 5

visual inspection; ?HgbA1c, ?STI testing

Question 6

Balanitis/Posthitis tx:

Answer 6

lotrimin +/- limited course of mild topical steroid; control DM; hygiene

Question 7

Phimosis:

Answer 7

inability to retract foreskin

Question 8

Phimosis etiology:

Answer 8

Physiologic: normal to age 4
Pathologic: usually feature of poor DM control in adult with monilial (yeast) posthitis; rarely traumatic

Question 9

Phimosis presentation:

Answer 9

penile pain; fissuring of foreskin; deflection/pain with erection; associated UTI; associated urinary retention

Question 10

Phimosis work-up:

Answer 10

good exam; urine C&S; ?urinary residual; ?HgbA1c

Question 11

Phimosis Tx:

Answer 11

Child: expectant until age 4, then topical steroid
If refractory, refer for consideration of circumcision
Adult: Nystatin +/- topical steroid ( Mycolog)

Question 12

Paraphimosis:

Answer 12

-Foreskin is stuck in retracted position, cannot be reduced

Question 13

paraphimosis etiology:

Answer 13

Iatrogenic – frequent feature of poor catheter care

Tight phimosis with retraction of prepuce

Question 14

Paraphimosis presentation

Answer 14

Edema, redness, pain
Glans can potentially be compromised
Need to ask patient, family, caregiver: “Circumcised?”
if they’re cicumcised they can’t have this!!!!

Question 15

paraphimosis tx:

Answer 15

Manual compression/reduction of edematous tissue
Dorsal slit (incise the foreskin in the OR)

Question 16

Urethritis:

Answer 16

inflammation of the urethra

Question 17

urethritis etiology:

Answer 17

STI, usually gonococcal or chlamydial

Question 18

urethritis presentation:

Answer 18

diffuse purulent d/c w/ dysuria

Question 19

urethritis work-up

Answer 19

urine probes, swabs

Question 20

urethritis tx:

Answer 20

treat as if for both G&C

Ceftriaxone/Cipro + Azithro/Doxy

Question 21

ED

Answer 21

-inability to obtain or maintain an erection

Question 22

ED etiology:

Answer 22

Vasculogenic (poor arterial inflow; veno-occlusive etiologies), neurogenic, medication adverse effect (psychotropics, antihypertensives), hormonal, psychogenic

RFs: DM, HTN, CAD, hyperlipidemia, smoking; surgery (radical prostatectomy); pelvic XRT

Exacerbated by hormonal milieu (low testosterone)

Up to 20% of patients with undiagnosed vascular disease will present with ED

Question 23

ED work-up:

Answer 23

Careful history (?maintain/attain; ?ejaculate; penile pain/curvature; ?partner satisfaction; ?stressors)
Blood pressure; genital exam
Total and free testosterone, fasting lipid panel

Question 24

ED tx:

Answer 24

relax cavernosal smooth muscle

Pills – PDE inhibitors (Viagra, Levitra, Cialis)
Injectable PGE1 (Caverject)
Penile PGE1 suppository (MUSE)
Vacuum erectile device
Surgery (prosthetics – rigid or inflatable)

Question 25

penile condyloma:

Answer 25

warts | -HPV related

Question 26

penile condyloma presentation:

Answer 26

bulky, solitary/multiple Can be superinfected Check anus

Question 27

penile condyloma diagnosis

Answer 27

largely clinical | Biopsy if atypical features (large, pigmentation, induration), refractory to treatment, immunocompromised, etc.

Question 28

penile condyloma tx:

Answer 28

Lesions: Chemical/physical destruction: podofilox, cryotherapy Immuno: Veregen, imiquimod (cytokine induction) Surgical excision, laser ablation (CO2, Holmium) Counseling: chronicity of the disease (no cure), partner notification, condoms can decrease (but not eliminate) risk, can be associated with other STIs

Question 29

Penile cancer:

Answer 29

- rare - associated with HPV - rare in circumcised men because its squamous skin cancer

Question 30

penis ca presentation:

Answer 30

Condylomata, penile swelling, balanitis, phimosis

Question 31

penis ca tx:

Answer 31

surgical Circumcision, partial penectomy, radical penectomy with urinary diversion (perineal urethrostomy) and lymph node dissection

Question 32

Penis ca prognosis

Answer 32

stage-dependent

Question 33

penis ca prevention

Answer 33

Prevention: ?circ ; HPV vaccine

Question 34

Urethral strictures:

Answer 34

``` Congenital Iatrogenic Treatment: -Dilation -Internal urethrotomy -Urethroplasty ```

Question 35

Priapism

Answer 35

Idiopathic Systemic disease- sickle cell, system cancers lymphomas Trauma- from venous blood flow Medications-trasadone,

Question 36

Peyronies dz:

Answer 36

Plaque deposition in tunica albugenia