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Penile Conditions + Cancer Flashcards

(62 cards)

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1
Q

Most common type of penile cancer

A

Squamous cell carcinoma

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2
Q

Types of penile cancer

A
  • squamous cell carcinoma (most common)
  • basal cell carcinoma
  • sarcoma
  • melanoma
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3
Q

What condition has a strong association with penile cancer?

A

HPV 16

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4
Q

Risks factors of penile cancer

A
  • HPV
  • phimosis
  • smoking
  • lichen sclerosis
  • untreated HIV infection
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5
Q

What is protective in penile cancer?

A

Circumcision

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6
Q

Features of penile cancer

A
  • palpable or ulcerating lesion on penis
  • most commonly on glans
  • painless
  • may discharge or bleed
  • inguinal lymphadenopathy
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7
Q

Differentials of penile cancer

A

Herpes simplex
Syphilis
Psoriasis
Balanitis

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8
Q

Investigations of penile cancer

A
  • penile biopsy
  • PET-CT imaging
  • CT TAP
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9
Q

Staging of penile cancer

A

TNM staging

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10
Q

Management of penile cancer

A
  • superficial non invasive: topic chemotherapy + follow up biopsy + surveillance | laser treatment |glans resurfacing
  • invasive confined to glans: local excision, partial glansectomy, total glansectomy with reconstruction
  • invasive penile cancer: partial amputation + reconstruction, total penectomy | + neoadjuvant radio or chemo
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11
Q

What is phimosis?

A

Foreskin/prepuce cannot be fully retracted in adult

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12
Q

When is phimosis normal?

A

In children under 2

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13
Q

What is paraphimosis?

A

The inability to pull forward a retracted foreskin over the glans penis

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14
Q

Risk factors of paraphimosis

A
  • phimosis
  • indwelling urethral catheter (due to non-replaced foreskin)
  • poor hygiene
  • prior paraphimosis
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15
Q

Presentation of paraphimosis

A
  • progressive pain + swelling of glans penis or distal prepuce after retraction of foreskin
  • inability to retract foreskin back over glans penis
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16
Q

Management of paraphimosis

A
  • reduction as soon as possible
  • suitable analgesia e.g. penile block via LA
  • dorsal slit or emergency circumcision if manual reduction fails
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17
Q

Methods of reduction of paraphimosis

A
  • manual pressure +/- lubricant jelly
  • application of dextrose soaked gauze: acts as osmotic effect + draws fluid out of glands, reducing oedema
  • Dundee technique: needle punctures in glands penis + squeezing area to allow drainage of oedematous fluid then manual reduction
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18
Q

What can untreated paraphimosis cause?

A

Progressive oedema to glands penis > necrosis

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19
Q

Indications for circumcision in children

A

Religion
Recurrent balanitis/UTI

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20
Q

Medical indications for circumcision

A
  • phimosis
  • recurrent balanitis
  • balanitis xerotica obliterans
  • paraphimosis
  • penile cancer
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21
Q

Benefits of circumcision

A
  • reduces risk of penile cancer
  • reduces UTI risk
  • reduces risk of STIs
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22
Q

What is balanitis?

A

Inflammation of glans penis

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23
Q

What is balanoposthitis?

A

Inflammation of glands penis + foreskin

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24
Q

Common casues of balanitis

A
  • candidiasis
  • dermatitis - contact, allergic, eczema, psoriasis
  • bacterial
  • anerobic
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25
Features of candidiasis balanitis
- Usually occurs after intercourse - associated with itching + white non-urethral discharge
26
Features of bacterial balanitis
- painful - itchy - yellow non urethral discharge - most commonly due o staph saprophyticus
27
Features of anaerobic balanitis
- itchy - very offensive yellow non urethral discharge
28
General treatment of balanitis
- gentle saline washes - education of hygiene - short course of 1% hydrocortisone
29
Specific treatment of balanitis due to: - candidiasis - bacterial - anaerobic - dermatitis
- **candidiasis**: topical clotrimazole for 14 days - **bacterial**: oral flucloxacillin - **anaerobic**: saline washes +/- topical or oral metronidazole - **dermatitis**: topical hydrocortisone
30
What is balanitis xerotica oblierans
Thin white scaly patch on foreskin
31
Management of balanitis xerotica obliterates
Circumcision
32
Pathophysiology of penile fracture
Traumatic rupture of corpus cavernosa + tunica albuginea in an erect penis
33
Causes of penile fracture
- penetrative intercourse with partner on top - forceful masturbation - falling from bed with erect penis
34
Presentation of penile fracture
- popping sensation/ snap - immediate pain - swelling - aubergine sign
35
Imaging of penile fracture
Cavernosography
36
Management of penile fracture
- analgesia - antiemetics - urgent surgical exploration + repair - via circumferential incision + penile skin de-gloved proximally to base + repair of tear using absorbable sutures - abstinence for6-8 weeks
37
What is Peyronie’s disease
Condition characterised by an acquired curvature to the penis due to fibrosis of tunica albuginea
38
Classification of Peyronie’s disease
- asymptomatic - moderate to severe curvature > pain or impeding sexual function - erectile dysfunction
39
Risk factors of Peyronie’s disease
- increasing age - diabetes mellitus - Ischaemic heat disease - HTN
40
Management of Peyronie’s disease -
- improve + maintain sexual function - phosphodiesterase-5 inhibitors *e.g. sildenafil* - vacuum erection pumps BD for 3-6 months - tunica plication surgery
41
What is priapism?
Unwanted painful erection lasting >4 hours + no associated with sexual desire
42
Classifications of priapism
- **high flow/non-ischaemic**: due to unregulated cavernous arterial inflow, associated with trauma - **low flow/ischaemic**: blockage in venous drainage of corpus cavernosum | urological emergency
43
Causes of priapism
- **non ischaemic**: after trauma - penile, perineal or spinal cord injury - **ischaemic**: sickle cell disease, leukaemia, thalassaemia
44
Investigations of priapism
- corporeal blood gas - routine bloods - duplex or Doppler USS
45
Management of priapism
- corporeal aspiration - intracavernosal injection of vasoconstrictive agent - surgical shunt
46
What is erectile dysfunction?
Persistent inability to attain + maintain an erection sufficient to permit satisfactory sexual performance
47
Factors favouring organic cause of ED
- gradual onset of symptoms - lack of tumescence (swollen?) - normal libdio
48
Factors favouring psychogenic cause of ED
- sudden onset - decreased libido - major life event - changes in relationship or problems - history of premature ejaculation - previous psychological problems
49
Risk factors of ED -
- increasing age - obesity - diabetes mellitus - metabolic syndrome - HTN - smoking - alcohol use - SSRIs - B blockers
50
Investigations of ED
- QRISK - free testosterone measured between 9-11am - if low, repeat with FSH, LH + prolactin
51
Management of ED
- phosphodiesterase-5 inhibitors *e.g. sildenafil (viagra)* - vacuum erection devices - for young men who have always had difficulty achieving erection > refer to urology - if cycling >3 hours per week, stop
52
Drug management of ED -
Phosphodiesterase-5 inhibitors *e.g. sildenafil, viagra*
53
How does viagra work in erectile dysfunction?
Phosphodiesterase-5 inhibitor Cause vasodilation through increase in cGMP > smooth muscle relaxation in blood vessels supplying corpus cavernosum
54
Contraindications to Viagra
- patient taking nitrates - hypotension - recent stroke or MI <6months
55
Side effects of Viagra
- blue discolouration of vision - nasal congestion - flushing - GI side effects - headache - priapism
56
What is fournier’s gangere
Form of necrotising fasciitis that affects the perineum Urological emergency
57
Risk factions of fournier’s gangere
- diabetes mellitus - excess alcohol intake - poor nutritional state - excess steroid use - haematological malignancies - recent trauma to region
58
Features of fournier’s gangere
- severe pain out of proportion to clinical signs - pyrexia - crepitus - skin necrosis - haemorrhagic bullae - sensory loss
59
Investigations of fournier’s gangere
- bloods - blood cultures - HbA1c - CT imaging
60
Diagnostic scoring system for necrotising fasciitis
Laboratory risk indicator for necrotising faciitis LRINEC
61
What blood test features are used in diagnosing necrotising fasciitis?
- CRP - white cell count - haemoglobin - sodium - creatinine - glucose
62
Management of fournier’s gangere -
- urgent surgical debridement - tissue histology + culture of debrided tissue - fluid culutre for pus - broad spec abx - transfer to high dependency unit - skin grafts

Urinary (30 decks)

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