PENILE AND URETHRAL DISORDERS Flashcards Preview

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Flashcards in PENILE AND URETHRAL DISORDERS Deck (32)
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1

1. What is the corpus cavernosum?

2. What is the corpus spongiosum and what runs through it?

1. Corpus cavernosum
-Two columns of tissue that run along side the penis that helps with erections

2. Corpus spongiosum
-Column of sponge like tissue that runs along the front and ending at the glans
-The urethra runs through the spongiosum

2

Disorders of the Urethra
4

1. Urethritis
2. Urethral stricture
3. Meatal stenosis
4. Hypospadius

3

Urethritis
1. What is it?
2. Who is it more common in?
3. Causes? 5

1. An inflammation of the urethra
2. Females greater than males
3. Causes
-Gonorrhea
-Chlamydia
-HPV
-Herpes simplex
-Idiopathic

4

Urethritis
Symptoms:
1. Males? 4
2. Females? 4

Symptoms
1. Males
-Dysuria
-Itching or burning at the meatus
-Hematuria/hematospermia
-Urethral discharge

2. Females
-Frequency
-Dysuria
-SP discomfort
-discharge

5

Urethritis
1. Dx? 2

2. Tx? (first line and FL alternative)
3. Alternatives? 2

1. Diagnosis
-UA and culture
-NAATs

2. Treatment
-Azithromycin 1g PO single dose
-Doxycycline 100mg bid x 7 days

3. Alternatives
-Erythromycin 500mg PO qid x 7 days
-Levofloxacin/Cipro 500mg PO once daily x 7 days

6

Urethritis
Treatment considerations? 4

1. Treat partner
2. Use condoms
3. Avoid irritants
4. NSAIDs

7

Urethral Stricture
1. What is it?
2. What are the two types?

1.
-A fibrotic band of tissue that renders the normal compliant urethral lumen inelastic
-Narrowing of the urethra with slowing of the urine

2. Two types
-Anterior: Begins at the bulbar urethra and end at the meatus
-Posterior: Involves the membranous and prostatic urethra

8

Urethral Stricture
Etiologies?
3

1. Trauma
2. Iatrogenic
3. Infection

9

How would the following cause urethral stricture?
1. Trauma? 2
2. Iatrogenic? 2
3. Infection? 2

1. Trauma
-Anterior urethra: Straddle injuries and penetrating injuries
-Posterior urethra: Urethral disruption from pelvic fracture

2. Iatrogenic
-Catheterization
-Surgical

3. Infection
-Gonococcal/Chlamydia

10

Urethral strictures:
1. Presentation? 3

2. Diagnosis? 3

1. Obstructive urinary symptoms
-Slow stream
-Decreased caliber
-Post-void dribbling

2. Dx
-Catheter
-Cystoscopy
-RUG

11

Urethral stricture: Tx? 3

1. Urethral dilation
2. DVIU
3. Urethroplasty

12

Meatal Stenosis
1. What is it?
2. More common in who?
3. Causes? 2
4. Symptoms? 3
5. Dx?
6. Tx?

1. Narrowing of the opening of the urethra at the tip of the penis

2. More common in males

3. Causes
-Swelling and irritation after newborn circ
-Idiopathic

4. Symptoms
-Spraying of stream
-Bed wetting
-Dysuria

5. Diagnosis
-Physical exam

6. Treatment
-Meatonomy

13

Hypospadius
1. What is it?
2. Occurs between what?
3. Presentation? 3

1. A congenital defect in which the opening of the urethra is on the underside of the penis

2. Occurs between the glands and penile-scrotal junction

3. Presentation
-Spraying of urine
-Having to sit down to void
-Foreskin makes the penis look like it has a “hood”

14

Hypospadius
1. DX?
2. Tx?
3. Tx complications? 2

1. Diagnosis
-Made usually at time of birth with physical exam

2. Treatment
-Surgical repair (4-18 months)
(Magpi and Snodgrass)

3. Complications
-Meatal stenosis
-Fistula

15

What are the penile disorders? 5

1. Balanitis
2. Phimosis
3. Paraphimosis
4. Peyronie’s Disease
5. Erectile Dysfunction

16

Balanitis
1. What is it?
2. Who is most affected?
3. Causes? 2
4. Presentation? 3

1. Inflammation of the glans penis

2. Uncircumcised men with poor hygiene most affected

3. Causes
-Infectious
-Non-infectious

4. Presentation
-Pain
-Irritation
-Itching/Burning

17

Balanitis
1. PE findings? 3
2. Dx? 3
3. Tx? 4

1. Physical Exam
-Erythema/Edema
-Discharge
-Ulceration

2. Diagnosis
-Culture discharge
-Wet mount
-Potassium hydroxide

3. Treatment
-Retraction of foreskin/wash with soap and water
-Bacitracin if bacterial infection suspected
-Topical clotrimazole for candidal infection
-Circumcision

18

Phimosis
1. What is it?
2. In children how may this progress?
3. Causes? 2
4. Complications? 4

1. Inability to retract the foreskin over the glans due to narrowing, constriction, or adhesions

2. In children phimosis may resolve on own

3. Causes
-Balanitis
-Poor hygiene

4. Complications
-Balanitis
-Paraphimosis
-Voiding problems
-Penile carcinoma

19

1. Phimosis
Presentation? 4

2. Tx? 2

1. Presentation
-Erythema
-Itching
-Discharge
-Pain with erection and intercourse

3. Treatment
-Betamethasone cream 0.05% bid
-Circumcision (alternative)

20

Paraphimosis
1. What is it?
2. Untreated can lead to what?
3. Tx? 2

1. Retracted foreskin becoming trapped proximal to the glans resulting in edema, inflammation, and pain

2. Untreated can lead to ischemia of the glans and eventual gangrene

3. Treatment
-Firm compression and manual reduction of the foreskin
-Circumcision

21

Peyronie’s Disease
1. What is it?
2. Usually affects men of what age?
3. Causes? 2
4. How many phases are there?

1. A curvature of the penis, particularly during erections.
Fibrosis and plaque formation of the tunica albuginea

2. Usually affects men aged 40-70 years old

3. Cause
-Vascular trauma
-Injury to the penis

4. Acute and chronic phase

22

Describe the acute (4) and chronic (3) phases of Peyronie’s Disease?

1. Acute: first 18-24 hours
Includes
-penile pain,
-some curvature,
-penile nodule, and
-inflammation

2. Chronic
Characterized by
-stable plaque,
-penile angulation, and
-loss of erectile ability

23

Peyronie’s Disease
Presentation? 5

Presentation
1. Penile pain
2. Penile angulation
3. Palpable plaque
4. Indentation in the shaft
5. Decreased erectile dysfunction

24

Peyronie’s Disease
1. Tx if dx in the first 6 months? 3
2. Tx after 6 months with a stable plaque? 2

1. Treatment: If diagnosed in first 6 months
-Vitamin E
-Ibuprofen
-Colchicine


2. After 6 month with stable plaque
-Injection therapy
-Surgery

25

Peyronie’s Disease
What kind of injection therapy?
2

1. Collagenase clostridiu histolyticum (Xiaflex)- Men with palpable plaque and at least 30 degree curvature

2. Verapamil
Weekly injections for 6 weeks

26

ED Definition?

Inability to achieve or maintain an erection for satisfactory sexual performance

27

Pathophysiology: Normal erectile response
5 steps

1. Interaction between neurotransmitter, biochemical, and smooth muscle response

2. Initiated by parasympathetic and sympathetic neuronal triggers

3. Integrate physiologic stimuli of the penis with sexual perception and desire

4. Nitric oxide produced from endothelial cells after parasympathetic stimuli triggers smooth muscle relaxation and arterial influx of blood

5. Compression of venous return follows producing an erection

28

1. ED risk factors? 5

2. Dx? 5

1. Risk factors
-HTN
-Smoking
-Diabetes mellitus
-Hyperlipidemia
-Obesity

2. Diagnosis
-International Index of Erectile Function Questionnaire
-Fasting serum glucose
-Lipid panel
-TSH
-Testosterone level

29

ED Tx
1. First line?
2. First line medications? 5

Treatment
1. First-line
Lifestyle modifications

2. First-line medications
Phosphodiesterase type 5 (PDE5) inhibitors
-Sildenafil (Viagra) 50-100mg
-Tadalafil (Cialis) 5mg daily or 10-20mg
-Vardenafil (Levitra) 10-20mg
-Avanafil (Stendra) 50-200mg

30

ED First-line medications
Phosphodiesterase type 5 (PDE5) inhibitors: SE?
5

Side-effects
1. HA,
2. flushing,
3. rhinitis,
4. abnormal vision
5. Do not take with nitrates