B33. Non-tumorous diseases of the penis and urethra

From greek.doctor

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
    • 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