Flashcards in Penile and Urethral Disorders Deck (25)
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
What is urethritis? Causes?
- an inflammation of the urethra
- females greater than males
Sxs of urethritis in males and females?
itching or burning at the meatus
Dx and tx of urethritis?
UA and culture
azithro 1 g PO single dose
doxy 100mg bidx 7 days
erythromycin 500mg PO qidx 7days
levofloxacin/cipro 500 mg once dailyx 7 days
- tx partner
- use condoms
- avoid acidic foods
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
Etiology of urethral strictures?
anterior urethra - straddle injuries, penetrating injuries
posterior urethra - urethral disruption from pelvic fracture
- iatrogenic: catheterization, surgical
Presentation and dx of urethral strictures?
obstructive urinary sxs -
catheter (if able to cath - doesn't have stricture)
Tx of urethral stricture?
- urethral dilation
What is a meatal stenosis? Causes? Sxs? dx? Tx?
- narrowing of opening of urethra at tip of penis
- more common in males
swelling and irritation after newborn circ, idiopathic
spraying of stream
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
spraying of urine
having to sit down to void
foreskin makes penis lool like it has a hood
Dx and tx of hypospadius?
- dx: made usually at time of birth w/ PE
surgical repair (4-18 months)
snodgrass (complications - meatal stenosis, fistula)
- don't circumcise - need skin to repair
What is Balanitis? Causes? Presentation?
- inflammation of glans penis
- uncircumcised men w/ poor hygiene most affected
- 3-11% of males
PE, dx and tx of balanitis?
retraction of foreskin/wash w/ soap and water
bacitracin if bacterial infection suspected
- topical clotrimazole for candidal infection
- circumcision - especially if recurrent
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
Presentation and tx of phimosis?
pain w/ erection and intercourse
betamethasone cream 0.05% bid
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
firm compression and manual reduction of foreskin, circumcision
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
injury to penis
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
Presentation of peyronie's disease?
- penile pain
- penile angulation
- palpable plaque
- indentation in shaft
- decreased ED
Tx of peyronie's disease?
- if dx in first 6 months:
after 6 month w/ stable plaque:
collagenase clostridiu histolyticum (Xiaflex) - men w/ palpable plaque and at least 30 degree curvature
-verapamil: weekly injections for 6 wks
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
under 59: 12%
over 69: 30%
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
RFs of ED?
- international index of erectile fxnl questionnaire
- fasting serum glucose
- lipid panel
- testosterone level