Urology 4: penoscrotal disease Flashcards
causes of erectile dysfunction
vascular - often first sign of IHD
neurological - diabetes, parkinsons, spinal injury
venogenic / cavernosal
hormonal - low testosterone
medication - anti-depressants, BBlockers
psychogenic
what are the two main catagories of erectile dysfunction
organic
psychological
how does the speed of onset impact whether ED is organic or psychological
gradual = organic
sudden = psychological
presence of early morning erection indicative of psychological
how could you investigate erectile dysfunction
vascular factors: BP, lipids, glucose, smoking
measure early morning testosterone
measure prolactin, LH, FSH
what is the main medication used to treat erectile dysfunction
sildenafil
PDE5 inhibitor
when is sildenafil contraindicated
those who require nitrates for ischaemic heart disease
as can cause a drop in BP by sudden vasodilation
what are some other management options for erectile dysfunction
treat low testosterone if needed
intraurethral prostaglandin or intracavernosal injections
vacuum tumescence device
penile prosthesis
what is phimosis
inability to fully retract the foreskin
due to the foreskin being tight
difficulty passing urine, pain, and cracking of the foreskin when the penis is erect
what are the different types of phimosis
physiological = normal in babies, most resolve by the age of 3
pathological = scarring of the foreskin opening, usually due to balanitis xerotica obliterans
what is the treatment for phimosis
topical steroids
circumcision
what is paraphimosis
urological emergency
the foreskin becomes trapped behind the corona of the glans penis
risk of glans necrosis
commonly linked to catheterisation
what is the management of paraphimosis
firm compression for 20 minutes untill the swelling reduces
then reduction
can contact urology if this fails
very rarely patient may need penile block+/- dorsal slit
what is fourniers gangrene
polymicrobial necrotising fasciitis of the perineal, perianal or genitals
causes thrombosis of the deep vessels, skin becomes ischaemic and can spread across the fascial plane
mortality of 50%
deteriorates over hours
what are some risk factors of fourniers gangrene
poorly controlled diabetes
alcoholism
obesity
indwelling catheter
what is peyronies disease
fibrous scar tissue that develops on the penis leading to curved erections
has acute phase where there is pain
corrected through surgery
linked to type 1 diabetes and duputrens contractures
what are some common causes of scrotal lumps
hydrocele
varicocele
epididymal cyst
testicular cancer
epididymo-orchitis
inguinal hernia
testicular torsion
what is a hydrocele
collection of fluid within the tunica vaginalis
painless irreducible soft fluctuant scrotal swelling
consider surgery if large and symptomatoc
what is a varicoele
veins in the pampiniform plexus become swollen
presents with discomfort, worse on standing, can lead to impaired fertility
‘bag of worms’ separate to the testes
can be managed with embolization
why are most varicoeles left sided
the left testicular vein drains to the left renal vein
can be caused by renal carcinoma or pathology
need to do renal and testicular USS
describe epipidymal cysts
soft round lump which is typically found at the top of the testes (head of the epididymis)
separate from the teste ‘third teste’
consider excision if large and symptomatic
caution in young people surgical intervention can cause scarring and affect fertility
