Paraphimosis

Paraphimosis refers to the situation where the foreskin is retracted and cannot be returned to original position. This causes oedema of the glans, which worsens the problem, potentially leading to ischaemia and necrosis. It therefore requires urgent management.

Management

Manual reduction after anaesthesia
- Local or regional anaesthesia
Surgery
Circumcision

Phimosis

Phimosis refers to when the foreskin cannot be completely retracted over the glans penis. This is physiological in early years, affects almost all newborn, but only 1% of seventh grade boys. In some, it does not spontaneously resolve.

Etiology

Congenital
Complication of balanitis
Scarring after trauma

Treatment

Topical glucocorticoids and stretching
Surgical incision of the constricting parts
Circumcision

Priapism

Priapism refers to an erection which lasts for more than 4 hours and which is not due to sexual excitation. It is not relieved by ejaculation.

Low-flow priapism
- Due to inadequate venous drainage
  - Sildenafil, sickle cell disease, other drugs, thrombosis, etc.
- Treatment
  - Cavernosal aspiration and irrigation
  - Phenylephrine
  - Surgery
High-flow priapism
- Not as urgent as low-flow, not painful
- Due to excessive arterial inflow
  - Injury -> fistula between artery and corpus cavernosum
- Treatment
  - Ice pack
  - Embolization of the fistula
  - Surgery

Balanitis

Balanitis refers to inflammation of the glans penis. Technically, the foreskin is usually inflamed as well, called balanoposthitis, but it's usually just called balanitis.

Etiology

Poor genital hygiene
Phimosis
STD
Yeast infection
Drug reaction
Local irritants

Clinical features

Pruritus
Pain
Oedema
Erythematous, ulcerated lesions

Diagnosis

Clinical
Bacterial culture
KOH test for fungal infection

Treatment

Treatment/prevention of underlying cause
Topical antifungal, antibiotic, glucocorticoids, etc.
Daily washing under foreskin
Avoid irritants

Peyronie disease

Peyronie disease is characterised by idiopathic fibroproliferative disorder causing formation of fibrous plaque in the tunica albuginea, causing painful erection and abnormal curving of the erect penis. It affects middle-aged and older men.

Clinical features

Painful erection
Abnormal curving of the erect penis
Indurations of the penis
Erectile dysfunction

Treatment

Pentoxifylline
Intralesional injection of collagenase
Surgery

Urethral stricture

Urethral stricture is a fibrotic narrowing of urethra.

Etiology

Trauma
Iatrogenic
- Catheterization
- Instrumentation
- Inappropriate removal of Foley catheter
Congenital
Idiopathic
Post-infectious

Clinical features

Causes partial or complete lower urinary tract obstruction
Slow urinary stream
Incomplete bladder emptying
Dribbling

Diagnosis

Uroflowmetry
- Shows a plateau
Retrograde and voiding urethrography

Treatment

Urethral dilation
- Symptomatic, not curative
Urethrotomy
- Endoscopic incision of stricture
- Stricture frequently recurs
Urethroplasty
- Open surgical reconstruction of stricture
- If urethrotomy fails