Penile Pathology Flashcards
(48 cards)
what is the autonomic nerve supply involved in erection?
Parasympathetic (S2-S4) discharge causes erection
sympathetic (T11-L2) discharge causes ejaculation and detumescence.
what are the organic causes of erectile dysfunction?
SMOKING, ALCOHOL,
DIABETES
Also hypogonadism, hyperthyroidism, ↑prolactin, cord lesions, MS, autonomic, trauma and pelvic surgery, Radiotherapy, Atheroma, Prostatic hyperplasia, post-priapism or Pyronines
what drugs can cause erectile dysfunction?
digoxin, B-blockers, diuretics, anti-psychotics, antidepressants, oestrogens, finasteride, narcotics
what are the psychological causes of erectile dysfunction?
o Depression
o Relationship problems
o Sexual orientation uncertainties
o Primary psychogenic erectile dysfunction
what is the clinical feature of erectile dysfunction?
Inability to achieve or maintain an erection
what investigations are required to diagnose erectile dysfunction?
- Full sexual and psychological history
- U&E, LFTs, glucose, TFT, LH, FSH, lipids, testosterone, prolactin
- +/- Doppler
what is the management of erectile dysfunction?
- Treat causes
- Counselling
- Lifestyle
- Medications
- Surgery – penile implant
what medications are involved in the management of erectile dysfunction?
o Phosphodiesterase-5 inhibitors eg. Sildenafil citrate (Viagra), tadalafil, vardenafil
o Intracavernosal injections of alprostadil +/- vacuum erection device
o Intracavernosal combination – alprostadil, papaverine, phentolamine
what is the pathophysiology of balantis?
inflammation of the foreskin and glans
what is the cause of balantits?
associated with strep and staph infections, more common in diabetics. Young children with tight foreskins
what is the management of balantis?
antibiotics, circumcision, hygiene advice
what is the pathophysiology of phimosis?
foreskin cannot be retracted behind the glans, occludes the meatus
what are the clinical features of phimosis?
o Young boys: Recurrent balanitis and ballooning
o Adults: painful intercourse, infection, ulceration, balanitis xerotica obliterans
o Overgrowth of bacteria behind foreskin – smegma bacillus
what is the pathophysiology of paraphimosis?
o Foreskin becomes trapped behind the glans penis and cannot be reduced
o Prevents venous return leading to oedema and even ischaemia of the glans
what is the cause of paraphimosis?
incorrect handling of foreskin – retraction for catherization or cystoscopy and not replaced properly, sex for first time, old age you has not/cannot
what are the clinical features of paraphimosis?
painful swelling of the foreskin distal to a phimotic rim, palpable tight band
what is the management of paraphimosis?
Ask patient to squeeze glans. Try applying a 50% glucose soaked swap. Ice packs and lidocaine gel may also help. May require aspiration/dorsal slit/circumcision.
o Retraction – ring block then squeeze for 20 mins “white knuckle pressure”
what are the causes of priapism?
- Idiopathic - 80%
- Intracorporeal injection for ED e.g. papaverine (low flow)
- Trauma (high flow)
- Haematological dyscrasias e.g. sickle cell
- Neurological conditions – spinal cord lesions
what is priapism?
prolonged priapism
what is the pathophysiology of low flow priapism?
o Excessive release of neurotransmitters, blockage of drainage venules, paralysis of the intrinsic mechanism, prolonged relaxation of the intracavernous smooth muscles
o Vascular stasis + decreased venous outflow = compartment syndrome
o Lots of deoxygenated blood in penis can cause necrosis and tissue damage
what is the pathophysiology of high flow priapism?
o Fistula between the cavernosal artery and the corpus cavernous = unregulated blood entry + filling of corporea
what are the clinical features of priapism?
- Prolonged erection
- Low flow – corpora cavernosa are rigid and tender, penis often painful
- High flow – not painful
how is priapism diagnosed?
Aspirate blood from corpus cavernosum – dark blood, low O2, high CO2 in low flow, normal arterial blood in high flow
Colour duplex – USS
o minimal or absent flow in cavernousal arteries in low flow
o normal to high flow in non-ischaemic priapism
what is the management of ischaemic priaprism?
aspiration +/- irrigation with saline, injection of alpha agonist e.g. phenylephrine 100-200micrograms every 5-10 mins up to max
surgical shunt, >7 hrs unlikely to respond, penile prosthetic
