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Flashcards in PENIS!!!!! Deck (37)
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1

Balanitis/Posthitis Etiology –

typically monilial (yeast; usually in poorly controlled DM)

2

Balanitis/Posthitis Work-up –

visual inspection;
HgbA1c,
STI testing

3

Balanitis/Posthitis Treatment –

lotrimin +/- limited course of mild topical steroid; control DM; hygiene

4

inability to retract foreskin

Phimosis

5

Phimosis etiology

Physiologic: normal to age 4

Pathologic: usually feature of poor DM control in adult with monilial (yeast) posthitis; rarely traumatic

6

Phimosis presentation

penile pain; fissuring of foreskin; deflection with erection; associated UTI; associated urinary retention

7

Phimosis work up

good exam; urine C&S;
urinary residual;
HgbA1c

8

Phimosis treatment

Child: expectant until age 4, then topical steroid
If refractory, refer for consideration of circumcision
Adult: Nystatin +/- topical steroid ( Mycolog)

9

foreskin is stuck in retracted position, cannot be reduced

Paraphimosis

10

Paraphimosis etiology

Iatrogenic – frequent feature of poor catheter care
Tight phimosis with retraction of prepuce

11

Paraphimosis presentation

Edema, redness, pain
Glans can potentially be compromised
Need to ask patient, family, caregiver: “Circumcised?”

12

Paraphimosis tx

Manual compression/reduction of edematous tissue
Dorsal slit (incise the foreskin in the OR)

13

inflammation of the urethra

Urethritis

14

Urethritis Etiology

STI (usually gonococcal, chlamydial)

15

Urethritis Presentation

diffuse purulent d/c with dysuria

16

Urethritis Work-up

urine probes, swabs

17

Urethritis Treatment

treat as if for both G&C
Ceftriaxone/Cipro + Azithro/Doxy

18

inability to obtain/maintain erection

Erectile Dysfunction (ED)

19

Erectile Dysfunction (ED) etiology

Vasculogenic (poor arterial inflow; veno-occlusive etiologies), neurogenic, medication adverse effect (psychotropics, antihypertensives), hormonal, psychogenic

20

Erectile Dysfunction (ED) risk factors

Up to 20% of patients with undiagnosed vascular disease will present with ED
DM, HTN, CAD, hyperlipidemia, smoking; surgery (radical prostatectomy); pelvic XRT

21

Erectile Dysfunction (ED) made worse by

hormonal milieu (low testosterone)

22

Erectile Dysfunction (ED) work up

Careful history (?maintain/attain; ?ejaculate; penile pain/curvature; ?partner satisfaction; ?stressors)
Blood pressure; genital exam
Total and free testosterone, fasting lipid panel

23

Erectile Dysfunction (ED) tx

relax cavernosal smooth muscle

Pills – PDE inhibitors (Viagra, Levitra, Cialis)
Injectable PGE1 (Caverject)
Penile PGE1 suppository (MUSE)
Vacuum erectile device
Surgery (prosthetics – rigid or inflatable)

24

penili wartz =

Penile Condyloma

25

Penile Condyloma etiology

HPV-related

26

Penile Condyloma presentation

bulky, solitary/multiple
Can be superinfected
Check anus
(may i check your anus please)

27

Penile Condyloma diagnosis

largely clinical
Biopsy if atypical features (large, pigmentation, induration), refractory to treatment, immunocompromised, etc.

28

Penile Condyloma tx

Lesions:
Chemical/physical destruction: podofilox, cryotherapy
Immuno: Veregen, imiquimod (cytokine induction)
Surgical excision, laser ablation (CO2, Holmium)

Counseling: chronicity of the disease (no cure), partner notification, condoms can decrease (but not eliminate) risk, can be associated with other STIs

29

Penile Cancer epidemiology

rare

30

Penile Cancer etiology

Associated HPV (16, 18, 31, 33), rare in circumcised men, it’s a skin cancer (squamous)