The Penis

Question 1

__ is inflammation of the glans penis or penile foreskin (red rocket ship)

Answer 1

Balanitis/posthitis

Question 2

What is the etiology of Balanitis/posthitis?

Answer 2

Yeast (usually in poorly controlled DM pts)

Question 3

What is the presentation and S/s of Balanitis/posthitis?

Answer 3

Glossy flat lesions of penis/foreskin

Blotchy erythema

Adhesions

Smegma; phimosis

Question 4

What are options for tx of Balanitis/posthitis?

Answer 4

Lotrimin

(+/-) limited course of mild topical steroid

Control DM

Proper hygiene

Question 5

___ is the inability to retract foreskin

Answer 5

Phimosis

Question 6

What are causes of Phimosis

Answer 6

Physiologic→ normal through 4 y/o

Pathologic→ usually feature of poor DM control in adult w/ monilial (yeast) posthitis; rarely traumatic

Question 7

What are the s/s of Phimosis

Answer 7

Penile pain
fissuring of foreskin
deflection w/ erection
associated UTI
associated urinary retention

Question 8

____ occurs when the foreskin is stuck in retracted position, cannot be reduced

Answer 8

Paraphimosis

Question 9

What is the etiology for Paraphimosis

Answer 9

Iatrogenic→ frequent feature of poor catheter care [most common]

Question 10

What are the s/s of paraphimosis

What is a potential complication?

Answer 10

Edema/ redness/pain

Glans can potentially be compromised

Question 11

What are the 2 tx options for paraphimosis?

Answer 11

Manual compression/reduction

Dorsal slit (incise the foreskin in the OR) (like a hot dog wrapped up in a crescent roll)

o(((((((3

Question 12

___ is inflammation of the urethra

Answer 12

Urethritis

Question 13

What is the etiology of urethritis?

Answer 13

STI (usually gonococcal, chlamydial)

Question 14

What are the S/s of Urethritis?

Answer 14

Diffuse purulent discharge w/ dysuria

Question 15

What is used to dx and tx urethritis?

Answer 15

Dx: urine probe, swab

Tx: Ceftriaxone/Cipro + Azithro/Doxy

Question 16

___ is the inability to obtain/maintain erection

Answer 16

ED

Question 17

What is the etiology for ED?

Answer 17

Vasculogenic (poor arterial inflow; veno-occlusive etiologies)

Neurogenic/psychogenic

Rx ADRs (psychotropics, antihypertensives)

Hormonal

Question 18

What are some RF for ED?

Answer 18

DM
HTN
CAD
HLD
Smoker

Question 19

Options for tx of ED?

Answer 19

PDE inhibitors (Viagra, Levitra, Cialis)

Injectable PGE1 (Caverject)

Penile PGE1 suppository (MUSE)

Vacuum erectile device

Surgery

Question 20

What is a penile condyloma?

Answer 20

Penile warts (ew!)

Question 21

What is the etiology for penile condyloma?

Answer 21

HPV

Question 22

What are the S/s of penile condyloma?

Answer 22

Bulky, solitary/multiple warts

Question 23

How is the dx for penile condyloma made? When should you bx a wart?

Answer 23

Clinically

Bx if atypical features, refractory to tx, and/or immunocompromised

Question 24

What is the tx for a penile condyloma?

Answer 24

Destruction: podofilox, cryotherapy

Immune rx: veregen, imiquimod

Surgical

Question 25

What are some counseling tips for pts w/ penile condyloma?

Answer 25

No cure
Tell partner (hey baby you got warts)
Use condoms
Associated w/ other STIs

Question 26

Penile CA is (common/rare)

Answer 26

Rare

Question 27

What are common etiologies for Penile CA?

Answer 27

HPV: 16, 18, 31, 33

Question 28

Who is less likely to get penile CA? (Circumcised or Uncircumcised pts)

Answer 28

Circumcised –> it is a squamous skin CA

Question 29

What are the S/s of penile CA

Answer 29

Condylomata
Penile swelling
Balanitis
Phimosis

Question 30

What are some prevention steps pts can take to reduce their risk of penile CA?

Answer 30

HPV vaccine; maybe circumcision

Question 31

Are urethral strictures congenital or iatrogenic?

Answer 31

BOTH!

Question 32

What is the tx for urethral strictures ?

Answer 32

Dilation
Internal urethrotomy
Urethroplasty