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Penis Flashcards

(54 cards)

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1
Q

Identify picture 2

A

Pearly penile papules

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2
Q

What are pearly penile papules

A

Benign papules on corona of glans. Due to uncircumcision

Often confused with condyloma acuminata

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3
Q

Identify picture 3

A

Prince Albert ring

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4
Q

Complication of Prince Albert ring

A

Urethral fistula

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5
Q

Why do people get Prince Albert ring

A

Increases sexual pleasure

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6
Q

Define priapism

A

Painful, prolonged (>6h) erection unaccompanied by sexual desire

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7
Q

Define Peyronie’s disease

A

Fibrous plaque involving tunica albuginea of penis causing penile pain on erection, chordee usually dorsal, erectile dysfunction.

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8
Q

Etiology of Peyronie’s disease

A

Repetitive microvascular trauma due to coitus (wound healing disorder causing prolonged inflammation and remodelling)

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9
Q

Clinical features Peyronie’s disease? (5)

A
  • Penile pain when erect
  • Penile curvature (chordee) usually dorsal (inelastic plaque restricts expansion )
  • loss of erections in late stage. (Interfere with veno-occlusive mechanism)
  • palpable plaque usually on dorsum, mid-shaft or distal penis.
  • later: penile shortening, narrowing, hourglass deformity.
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10
Q

Risk factors Peyronie’s disease? (5)

A 
• Middle aged 40-60
• connective tissue disorder (20% have associated Dupuytren's contracture)!
• diabetes
• post radical prostatectomy
. Hypertension
• hypogonadism
• smoking
• familial predisposition, vascular disease
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11
Q

Treatment Peyronie’s disease? (4)

A

• 50% resolve spontaneously within a year.
• penile pain: vitamin E and colchicine ( gout medication), NSAIDs orally or intralesional injection with verapamil (ccb), collagenase or interferon. None of these very successful.
• penile curvature: surgery if unable to have intercourse and disease stabilised.
- Nesbit procedure (plication) ( disadvantage penile shortening) (most common)
- excision of plaque (complex)
- shock therapy
• loss erections: medications like pde5 inhibitors unsatisfactory, need penile implant if loss function .

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12
Q

What is BXO?

A

Balanitis xerotica obliterates, or lichen sclerosis et atrophicus

pre-malignant white patch on glans and penis from chronic infection, phimosis

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13
Q

Treatment penile leukoplakia?

A

Local excision

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14
Q

Treatment condyloma acuminatum?

A

• Podophyllin
. Fulgaration (diathermy)
• cryotherapy

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15
Q

What is bowenoid papulosis

A
  • Rare, sexually transmitted disorder caused by HPV 16.
  • resemble cis
  • many papules or flat granular lesions, reddish brown or violet, solid, velvety
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16
Q

What is condyloma acuminatum

A

• Genital wants caused by HpV 16 and 18.
• pre-malignant, associated with SCC of penis
- soft, multiple lesions on glans, prepuce and shaft.

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17
Q

Treatment of penile cancer (primary lesion and lymph nodes)? (6)

A

• Primary lesion: surgical under antibiotic cover
Confined to foreskin: circumcision
- glans or distal shaft: partial penectomy
- proximal shaft; total penectomy and perineal urethrostomy
- small lesions: radiotherapy (external beam or brachytherapy ) (low chance lymph involve)

•lymph nodes:

  • radical inguinal node dissection only if malignant nodes confirmed on aspiration cytology (high complication rate)
  • Rest of cases bilateral modified inguinal node dissections
  • Inoperable inguinal nodes (fixed or ulcerated) must be treated to avoid ulceration and haemorrhage: initial chemo → salvage surgery (best) or radiotherapy
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18
Q

What is the factor associated with the worst prognosis in penile cancer?

A

Iliac lymph node involvement. No chance of 5 year survival.

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19
Q

Define erectile dysfunction

A

Consistent, > 3 months, or recurrent inability to obtain or maintain an adequate erection sufficient for penetration and successful intercourse

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20
Q

Describe the normal physiology and steps of an erection (6)

A

1 psychogenic erections mediated by central erection centres ;
reflexogenic by genital stimulation mediated peripherally by spinal cord erection centres: s2-s4 parasympathetic ( Point );
Nocturnal erections during REM sleep mediated by central
(somatic : dorsal penile, cavernous and pudendal nerves must be intact too)

  1. Nitric oxide released in corpora cavernosa from NANC neurons and endothelium
  2. NO activate guanylate cyclase → increased cyclic guanosine monophosphate (CGMP ) from GTP → sinuosidal smooth muscle relaxation

4 increased blood flow to penis: iliac arteries → internal pudendal → cavernous → helicine arteries of penis

  1. Increased intracavernosal pressure causing venous obstruction to maintain erection
  2. normal hormone environment (testosterone, prolactin and thyroid) is necessary.
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21
Q

Describe the normal physiology and steps of an ejaculation (4)

A
  • Sensory afferents from glans
  • secretions from prostate , seminal vesicles and ejaculatory ducts enter prostatic urethra (sympathetic T10/11- L2 )
  • bladder neck closure (sympathetic)
  • spasmodic contraction of bulbocavernosus and pelvic floor muscles (somatic)
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22
Q

Describe the normal physiology and steps of an detumescence (4)

Study These Flashcards
A
  • Mediated by sympathetic t10 /11 - L2 via alpha receptors (norepinephrine/noradrenaline), endothelin 1
  • breakdown cGMP to GMP in corpora cavernosa mediated by phosphodiesterase type 5 (pde5)
  • arteriolar and sinusoidal constriction
  • venous outflow
23
Q

What type of erectile dysfunction will not have morning erections?

Study These Flashcards
A

Organic ED (psychogenic will still have)

24
Q

Name 10 organic causes of erectile dysfunction

Study These Flashcards
A

• Vasculogenic:

  • decreased arterial inflow: large vessel disease eg iliac arteries, small vessel disease eg diabetic vasculopathy
  • Venous leak: congenital abnormal venous channels or “leaky” tunica albuginea of corpus cavernosa

• neurogenic

  • CNS: CVA, Alzheimer’s, multiple sclerosis
  • Spinal cord: traumatic paraplegia
  • peripheral nerves: diabetic autonomic neuropathy
  • diabetes mellitus
  • endocrine: decreased serum testosterone, especially loss libido
  • trauma: pelvic #
  • surgery: radical prostatectomy!, radical cystectomy, penectomy, bilateral orchidectomy, resection rectal carcinoma

A radiotherapy: external beam or brachytherapy for prostate cancer

• drugs (As)

  • antihypertensives except alpha blockers and CCBS (neutral)
  • antiandrogens: spironolactone, oestrogens
  • antidepressants: tricyclic (increase serum prolactin mainly delayed ejaculation )
  • antipsychotics: typical tranquilisers (increase serum prolactin)
  • Alcohol, smoking, recreational drugs
  • alpha stimulants
  • antihistamines- h2 receptor antagonists (increase serum prolactin)
  • chronic systemic disease: heart, obstructive airway disease, renal failure, liver disease
  • penile problems: peyronie , chordee, neglected priapism, microphallus
25
Classification of erectile dysfunction and major differences? (7) prevalence, onset, frequency, variation, age, risk factors, nocturnal erections
Psychogenic VS organic • 10% vs 90% • sudden vs gradual • sporadic vs always • vary with partner and circumstance vs no variation • younger vs older • no organic risk factors vs risk factors • nocturnal and morning erection present vs absent
26
Investigations for erectile dysfunction? (5)
• History sexual function assessment: ED, libido, ejaculation, orgasm, sexually related genital pain • exams: secondary sex characteristics, penile deformities, bp, PvD, neurological examination s 2 -s4, . urine dipstick for glycosuria and fasting blood glucose • lipid profile • serum testosterone if clinically indicated (low libido, tropic testes ) Etc
27
Non-invasive Treatment erectile dysfunction? (4)
* Lifestyle changes: alcohol, smoking * psychological: sexual counselling and education * change precipitating medications * treat underlying causes:DM, CvD, ht, endocrinopathies
28
Minimally invasive Treatment erectile dysfunction? (3)
* Oral medication: first line = pde5 inhibitors: sildenafil (viagra!) 50 mg, tadalafil (cialis!) 20 mg, vardenafil (levitra!)(increase intracavernosal cgmp) * vacuum devices: draw blood into penis via negative pressure, then put constriction ring at base of penis. Can be used for all types of ED but is cumbersome. * MUSE: male urethral suppository for erection- vasoactive substance (pge1- alprostadil ) capsule inserted into urethra
29
Identify pathology picture 6
Peyronie's disease
30
Label picture 8 cross section of penis
See picture 9
31
What is the most common form of male sexual disfunction?
Premature ejaculation. Almost always psychogenic
32
Treatment premature ejaculation? (4)
* Topical lidocaine-prilocaine spray, remicaine lotion * ssri eg sertraline, fluoxetine = worst sexual side effects of ssri eg loss libido, ED * TCA eg clomipramine works best, but worst sexual side effects of TCAs; imipramine much better for side effects * NDRI bupropion least side effects!
33
Name 2 secondary causes of premature ejaculation
* Hyperthyroidism | * prostatitis
34
Name 3 causes phimosis
* congenital: 90% natural separation by age 3 * banalitis (foreskin and glans). * poor hygiene * traumatic
35
What is pathological phimosis?
Unable to retract foreskin at puberty
36
Name 4 treatment options phimosis
Physiological will settle by itself • Proper hygiene • topical corticosteroids for mild and moderate • dorsal slit • circumcision if pathological and severe
37
Name 5 symptoms short frenulum
• Concord penis when erect • Discomfort or pain in penis during erection • premature ejaculation • tearing and bleeding underneath head of penis . Trouble pulling back foreskin
38
Name 5 causes frenulum breve
* Congenital mostly * Balanitis * balanoposthitis * STDs causing banalities * skin conditions
39
Treatment short frenulum?
* Stretching and steroid creams * frenuloplasty * frenulectomy * circumcision
40
Name 5 complications phimosis
* balanitis, * posthitis, * paraphimosis, * voiding dysfunction, * penile carcinoma * prepuce calculi * obstruction to urine flow - hydronephrosis or ureter
41
Name 3 possible etiologies hypospadias
•Genetic, family history • maternal: SGA, monochorionic twins, GHT, oligohydramnios, preterm delivery, IVF and icsi Hormonal: disruption prenatal androgen exposure, fetal exposure to maternal oestrogen
42
Name the grading of hypospadias
Grade 1: glanular opening Grade 2: distal Grade 3: proximal Grade 4: opening in scrotum to perineum
43
Define paraphimosis
Retracted foreskin behind glans penis that cannot be reduced
44
Name 3 causes paraphimosis
* Iatrogenic: post cleaning or instrument * Trauma * infections: balanitis, balanoposthitis
45
Clinical features paraphimosis? (3)
* Painful, swollen glans penis due to obstruction venous and lymphatic drainage * constricting band proximal to Corona - donut shape * dysuria, decreased urinary stream in children
46
Treatment paraphimosis?
* penile ring block using lignocaine without adrenaline * emergency: reduce. Constant pressure on glans forces interstitial fluid out of glans and foreskin, allowing reduction * if this is unsuccessful, incise band dorsally. * definitive treatment = circumcision
47
Classification and pathogenesis of priapism?
• Low flow / veno-occlusive/ ischaemiac - common - persistent arterial inflow - corpus cavernosa only - dark blood on aspiration • high flow/ arterial / non- ischaemic - uncommon - Most commonly due to perineal trauma causing AVF - bright red blood on aspiration because no ischaemia - Corpus cavernosum and spongiosum - Painless, good prognosis • (recurrent/stuttering - variant of ischaemic brought on with REM sleep)
48
Differential diagnosis of genital ulcers? (13)
``` STD . Syphilis/lues • chancroid (haemophilus ducreyi) • lymphogranuloma venereum (chlamydia) • granuloma inguinale (calymmatobacterium granulomatis) • herpes simplex virus ``` Pre-malignant lesions • carcinoma in situ • leukoplakia • Malignant: squamous carcinoma of penis . Traumatic ulcer eg during intercourse . Tb * non specific * allergic * behcet's syndrome
49
Describe syphilitic genital ulceration:organism, incubation, pyrexia, primary lesion, multiplicity, pain, depth, edges, base, induration, inguinal lymph nodes
* Treponema palladium * incubation 20-25 days * no pyrexia * Primary lesion papule at coronal sulcus * single painless * deep * edges well defined! * base smooth non-purulent! * induration firm * firm, non tender! Bilateral inguinal lymph nodes with no complications!
50
Describe chancroid genital ulceration:organism, incubation, pyrexia, primary lesion, multiplicity, pain, depth, edges, base, induration, inguinal lymph nodes and complications
* Haemophilus ducreyi * incubation 1-14 days * pyrexia * primary lesion papule * Multiple * painful * deep * irregular edges * purulent base * soft induration! * tender, unilateral inguinal lymph nodes with suppuration, sinus formation, genital lymphoedema
51
Describe lymphogranuloma venereum genital ulceration:organism, incubation, pyrexia, primary lesion, multiplicity, pain, inguinal lymph nodes and complications
* Chlamydia trachomatis * incubation 3-40 days * pyrexia * primary lesion vesicle! * single painless superficial! * tenders unilateral inguinal lymph nodes with suppuration, sinus formation, genital lymphoedema * other: rectal stenosis
52
Describe granuloma inguinale genital ulceration:organism, incubation, pyrexia, primary lesion, multiplicity, pain, depth, edges, base, induration, inguinal lymph nodes and complications
* Calymmatobacterium granulomatis * incubation 2-3 months! (Longest) * no pyrexia * primary lesion papule * single or multiple, painless * elevated! * edges elevated / irregular * red, rough base! * firm induration * inguinal lymph nodes granulomatous swelling with skin ulceration!, inguinal sinuses,genital lymphoedema * other: rectal stenosis
53
Describe herpes simplex genital ulceration:organism, incubation, pyrexia, primary lesion, multiplicity, pain, depth, edges, base, induration, inguinal lymph nodes
* HSV 2 * incubation 2-10 days! (Shortest) * no pyrexia * primary lesion vesicle * multiple * painful * superficial! * edges erythematous ! * base serous! * no induration! * tender, bilateral inguinal lymph nodes
54
Differential diagnosis penis oedema? (8)
``` Balanoposthitis progressing to cellulitis Urine extravasation Idiopathic lymphoedema of penis and scrotum, acutely painful Bee or insect sting Early Fourneirs Congestive heart failure Nephrotic syndrome with anasarca Elephantiasis ```

Urology (18 decks)

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