Urology 4: penoscrotal disease

Question 1

causes of erectile dysfunction

Answer 1

vascular - often first sign of IHD
neurological - diabetes, parkinsons, spinal injury
venogenic / cavernosal
hormonal - low testosterone
medication - anti-depressants, BBlockers
psychogenic

Question 2

what are the two main catagories of erectile dysfunction

Answer 2

organic
psychological

Question 3

how does the speed of onset impact whether ED is organic or psychological

Answer 3

gradual = organic
sudden = psychological

presence of early morning erection indicative of psychological

Question 4

how could you investigate erectile dysfunction

Answer 4

vascular factors: BP, lipids, glucose, smoking
measure early morning testosterone
measure prolactin, LH, FSH

Question 5

what is the main medication used to treat erectile dysfunction

Answer 5

sildenafil
PDE5 inhibitor

Question 6

when is sildenafil contraindicated

Answer 6

those who require nitrates for ischaemic heart disease
as can cause a drop in BP by sudden vasodilation

Question 7

what are some other management options for erectile dysfunction

Answer 7

treat low testosterone if needed

intraurethral prostaglandin or intracavernosal injections

vacuum tumescence device

penile prosthesis

Question 8

what is phimosis

Answer 8

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

Question 9

what are the different types of phimosis

Answer 9

physiological = normal in babies, most resolve by the age of 3
pathological = scarring of the foreskin opening, usually due to balanitis xerotica obliterans

Question 10

what is the treatment for phimosis

Answer 10

topical steroids
circumcision

Question 11

what is paraphimosis

Answer 11

urological emergency
the foreskin becomes trapped behind the corona of the glans penis
risk of glans necrosis
commonly linked to catheterisation

Question 12

what is the management of paraphimosis

Answer 12

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

Question 13

what is fourniers gangrene

Answer 13

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

Question 14

what are some risk factors of fourniers gangrene

Answer 14

poorly controlled diabetes
alcoholism
obesity
indwelling catheter

Question 15

what is peyronies disease

Answer 15

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

Question 16

what are some common causes of scrotal lumps

Answer 16

hydrocele
varicocele
epididymal cyst
testicular cancer
epididymo-orchitis
inguinal hernia
testicular torsion

Question 17

what is a hydrocele

Answer 17

collection of fluid within the tunica vaginalis
painless irreducible soft fluctuant scrotal swelling
consider surgery if large and symptomatoc

Question 18

what is a varicoele

Answer 18

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

Question 19

why are most varicoeles left sided

Answer 19

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

Question 20

describe epipidymal cysts

Answer 20

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