Penile and Urethral Disorders Flashcards Preview

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Flashcards in Penile and Urethral Disorders Deck (25)
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1

What is the corpus cavernosum? Corpus spongiosum?

- corpus cavernosum: 2 columns of tissue that run along side of penis that helps w/ erections
- corpus spongiosum: column of sponge like tissue that runs along front and ending at glans, urethra runs through the spongiosum

2

What is urethritis? Causes?

- an inflammation of the urethra
- females greater than males
- Causes:
gonorrhea
chlamydia
HPV
herpes simplex
idiopathic

3

Sxs of urethritis in males and females?

- males:
dysuria
itching or burning at the meatus
hematuria/hematospermia
urethral d/c

- females:
frequency
dysuria
SP discomfort
d/c

4

Dx and tx of urethritis?

- dx:
UA and culture
NAATs

-tx:
azithro 1 g PO single dose
doxy 100mg bidx 7 days
- alt:
erythromycin 500mg PO qidx 7days
levofloxacin/cipro 500 mg once dailyx 7 days
- tx partner
- use condoms
avoid irritants
- NSAIDs
- avoid acidic foods

5

What is a urethral stricture?

- a fibrotic band of tissue that renders the normal compliant urethral lumen inelastic
- narrowing of urethra w/ slowing of urine
- 2 types:
anterior: begins at bulbar urethra and ends at meatus (straddle injuries, falling off of a bike)
posterior: involves membranous and prostatic urethra

6

Etiology of urethral strictures?

- trauma:
anterior urethra - straddle injuries, penetrating injuries
posterior urethra - urethral disruption from pelvic fracture
- iatrogenic: catheterization, surgical
- infection:
gonococcal/chlamydia

7

Presentation and dx of urethral strictures?

- presentation:
obstructive urinary sxs -
slow stream
decreased caliber
post-void dribbling
- dx:
catheter (if able to cath - doesn't have stricture)
cystoscopy
RUG

8

Tx of urethral stricture?

- urethral dilation
- DVIU
- urethroplasty

9

What is a meatal stenosis? Causes? Sxs? dx? Tx?

- narrowing of opening of urethra at tip of penis
- more common in males
- Causes:
swelling and irritation after newborn circ, idiopathic
- sxs:
spraying of stream
bed wetting
dysuria
- dx:
physical exam
- Tx:
meatonomy

10

What is hypospadius? How common is this? Presentation?

- congenital defect in which opening of urethra is on underside of penis
- 1/300 boys
- 14% siblings
- 8% in offspring
- occurs b/t glands and penile scrotal jxn
- presentation:
spraying of urine
having to sit down to void
foreskin makes penis lool like it has a hood

11

Dx and tx of hypospadius?

- dx: made usually at time of birth w/ PE
- tx:
surgical repair (4-18 months)
magpi
snodgrass (complications - meatal stenosis, fistula)
- don't circumcise - need skin to repair

12

What is Balanitis? Causes? Presentation?

- inflammation of glans penis
- uncircumcised men w/ poor hygiene most affected
- 3-11% of males
- causes:
infectious
non-infectious
- presentation:
pain
irritation
itching/burning

13

PE, dx and tx of balanitis?

- PE:
erythema/edema
D/C
ulceration
- dx:
culture d/c
wet mount
KOH
-tx:
retraction of foreskin/wash w/ soap and water
bacitracin if bacterial infection suspected
- topical clotrimazole for candidal infection
- circumcision - especially if recurrent

14

What is Phimosis? Causes? Complications?

- inability to retract foreskin over glans due to narrowing, constriction, or adhesions
- in kids phimosis may resolve on own
- 1-5% of male by age of 16
- causes:
balanitis
poor hygiene
- complications:
balanitis
paraphimosis
voiding problems
penile carcinoma

15

Presentation and tx of phimosis?

- presentation:
erythema
itching
d/c
pain w/ erection and intercourse
- tx:
betamethasone cream 0.05% bid
circumcision (alt)

16

What is paraphimosis? Tx?

- retracted foreskin becoming trapped proximal to glans resulting in edema, inflammation, and pain
- untx can lead to ischemia of glans and eventual gangrene
- tx:
firm compression and manual reduction of foreskin, circumcision

17

What is Peyronie's Disease? Cause?

- curvature of penis, particularly during erections
- fibrosis and plaque formation of tunica albuginea
- usually affects men aged 40-70 yo
- cause:
vascular trauma
injury to penis

18

Acute and chronic phase of peyronie's disease?

- acute: first 18-24 hrs - includes penile pain, some curvature, penile nodule, and inflammation
- chronic: characterized by stable plaque, penile angulation, and loss of erectile ability

19

Presentation of peyronie's disease?

- penile pain
- penile angulation
- palpable plaque
- indentation in shaft
- decreased ED

20

Tx of peyronie's disease?

- if dx in first 6 months:
Vitamin E
ibuprofen
colchicine

after 6 month w/ stable plaque:
-injection therapy:
collagenase clostridiu histolyticum (Xiaflex) - men w/ palpable plaque and at least 30 degree curvature
-verapamil: weekly injections for 6 wks
- surgery

21

What is ED? Prevalence?

- inability to achieve or maintain an erection for satisfactory sexual performance
- MC sexual problem in men: affect relationships, quality of life, self-esteem
- prevalence:
under 59: 12%
60-69: 22%
over 69: 30%

22

Normal erectile response?

- interaction b/t neurotransmitter, biochemical and smooth muscle response
- initiated by parasympathetic and sympathetic neuronal triggers
- integrate physiologic stimuli of penis w/ sexual perception and desire
- nitric oxide produced from endothelial cells after parasympathetic stimuli trigger smooth muscle relaxation and arterila influx of blood
- compression of venous return follows producing an erection

23

RFs of ED?

- HTN
- smoking
- DM
- hyperlipidemia
- obesity

24

Dx ED?

- international index of erectile fxnl questionnaire
- fasting serum glucose
- lipid panel
- TSH
- testosterone level

25

Tx of ED?

- 1st line: lifesyle modifications - tx HTN, exercising, diet
- 1st line meds:
PDE5 inhibitors -
sildenafil (viagra) 50-100mg
tadalafil (cialis) 5mg daily or 10-20 mg
vardenafil (levitra) 10-20 mg
avanafil (steward) 50-200 mg
-SE: HA, flushing, rhinitis, abnormal vision
- Don't take w/ nitrates

-2nd line:
alprostadil (caverject) injection (SE: priapism)
vacuum pump device
muse 125-100-mcg intraurethrally
- 3rd line and last:
inflatable penile prosthesis