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Flashcards in Penile conditions Deck (28):
1

peyronie's dz

scarring of tunica albuginea leading to formation of plaques that can cause painful erection and dorsal curvature
MC in caucasian males > 40
Can cause significant psychological distress
Sx: painful erection, dorsal curvature, indentation, palpable plaque, penile shortening, ED

2

Risk factors for peyronie's dz

trauma
Family Hx of HLA-B27 or HLA-DQ5 positive
Paget, gout, lipoma, DM, HTN

3

Diagnosis for peyronie's dz

1. Family history of wound healing disorder?
2. Palpation – typically find plaque on the dorsal surface of the penis when stretched
3. Examine hands and feet for thickening or nodules
4. Dynamic penile duplex U/S to see calcification and/or biopsy to rule out penile CA
5. Investigate other causes of ED (age, smoking, hyperlipidemia, HTN, DM)

4

Tx of peyronei's dz

Couple counseling
L-argenine
Surgery
Inter-plaque injections

5

Phimosis

foreskin can't be retracted back away from gland penis

6

phimosis: physiologic vs pathologic

physiologic- boys: 50% will resolve by age 10, don't force retraction
pathologic- pain, constriction, meatus blockage due to adhesion

7

risk factors for phimosis

frequent diaper rash
poor hygiene
use of: condom, catheter, DM
lichen sclerosis

8

treatment for phimosis

self stretching of foreskin (DON"T elicit pain)
topical steroids
calendula cream with cenetella and Vit E
last resort: dorsal slit or circumcision

9

paraphimosis

foreskin stuck in retracted position and becomes inflamed leading to reduced blood flow to gland penis can cause gangrene or necrosis

10

treatment of paraphimosis

ice
apply firm pressure to foreskin for 5 min to reduce blood flow then try to gently replace it over glans
penile block
dorsal slit

11

balanitis

inflammation of glans penis (circumcised males)

12

balanoposthitis

inflammation of glans and foreskin

13

causes of balanitis/balanoposthitis

infxn (Candida MC)
dermatologic (psoriasis, contact derm)
pre/malignancy
drug reaction

14

sx of balanitis/balanoposthitis

pain during or after urination
discharge from inflamed tissue
local erythema
edema

15

risk factors for balanitis/balanoposthitis

Risk factors for balanitis:
  Use of antibiotics, DM, HIV positive, condom catheter use, circumcision procedure, STI contact, zipper injury, obesity, conditions that cause edema (eg CHF, cirrhosis, nephrotic syndromes)
Risk factors for balanoposthitis
  All of the above plus poor foreskin hygiene, phimosis 

16

dx of balanitis/balanoposthitis

history and PE generally diagnostic

17

tx of balanitis/balanoposthitis

hygiene: wash with saline
antifungal to treat candida
antibiotics for bacterial infection
topical steroids
curcumin, bromelain, fish oils
warm compress, sitz baths

18

benefits of circumcision

Easier hygiene
Reduction in UTI      
Reduction in penile CA risk?
Lower prevalence of HPV, lower cervical cancer rates in partners
Reduction in penile inflammation and phimosis

19

condylomata acuminata

(HPV)
blood spotting from the urethra, may see papilloma protruding

20

which high risk strain of HPV is associate with penile CA?

#16

21

condylomata acuminata (HPV) treatment options

Local excision/fulguration, or transurethral fulguration if deeper 
Condylox (podophyllotoxin) gel application
Liquid nitrogen application
Examine and treat sexual partner plus condom use-- to help prevent recurrences (Anal pap smear if anal sex is performed)
Gardasil vaccine now being tested for young men 9-26 yo  (3 injection series)

22

pearly penile papules

benign
occurs in 30% of men
1-2 mm fleshy or white, dome-shaped papules
arranged around the corona

23

tx of pearly penile papules

local application of liquid nitrogen
laser
radiosurgery

24

precancerous dermatologic lesions

leukoplakia
balanitis xerotica obliterans
giant conylomata acuminata

25

cancerous penile lesion

carcinoma in situ (bowen disease, erythroplasia of Queyrat)
invasive carcinoma of the penis (MC)

26

sx of invasive carcinoma of penis

Penile lesion: indurated or erythematous, ulcerated, nodular or exophytic growth; lesion necrosis, foul odor, bleeding, suppuration 
Phimosis may obscure lesion
MB pain, discharge, irritative voiding sx 

27

signs of invasive carcinoma of penis

Evaluate size, location, any dissemination (nodal involvement)
Inguinal lymph nodes

28

Laboratory for IC of penis

Usu normal, may see anemia or leukocytosis 
Hyperxcalcemia if osseous mets in 20% of pts