The NCCPA™ PANCE Genitourinary Content Blueprint penile disorders
Erectile dysfunction | Hypospadias/epispadias | Paraphimosis/phimosis | |
Description | Inability to achieve or maintain an erection sufficient for sexual intercourse | A birth defect in which the opening of the urethra is not at the tip of the penis | A condition in which the foreskin is retracted behind the glans penis and cannot be pulled back forward |
Symptoms | Difficulty achieving or maintaining an erection | The urethral opening is not at the tip of the penis
Epispadias is when the urethra opens onto the topside of the penile shaft Hypospadias (more common than epispadias) is when the urethra opens onto the bottom (underside) of the penile shaft |
The foreskin is retracted behind the glans penis and cannot be pulled back forward |
Causes | Vascular disease, neurological disorders, hormonal imbalances, medications, psychological factors | Genetics, environmental factors | Recurrent retraction of the foreskin, inflammation of the foreskin, trauma to the penis |
Treatment | Lifestyle changes, medications, surgery | Treatment is surgical repair, usually performed before 1-2 years of age | Treat with betamethasone topically. If there is no improvement - circumcision |
Erectile dysfunction | Patient will present as → a 60-year-old man who presents to your clinic for evaluation of erectile dysfunction. His wife died 5 years ago and he would like to start dating again. He denies having any life stressors. He reports having no morning or night-time erections. His past medical history includes hyperlipidemia managed with medication and pre-diabetes managed with an active lifestyle and diet. Occurs when a man can't get or keep an erection firm enough for sexual intercourse
DX: Detailed history and examination, including a DRE and neurologic examination. Assess for signs of PAD
TX: Treat with phosphodiesterase 5 inhibitors Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra)
|
Hypospadias/epispadias |
Epispadias is when the urethra opens onto the topside of the penile shaft Patient with epispadias will present as → a 2-year-old boy is brought to the clinic by his parents due to concerns about abnormal urination. The parents report that the child’s urine stream appears misdirected and sprays upward. On examination, the urethral opening is observed on the dorsal surface (upper side) of the penis, near the base of the glans. The child is diagnosed with epispadias. He is referred to a pediatric urologist who explains that this is a rare congenital condition and discusses the potential for surgical correction to improve the function and appearance of the genitalia, as well as to prevent future urinary issues.
DX: Diagnosis is usually made during the newborn exam, but imaging studies (excretory urogram) can aid in the diagnosis TX: Treatment is surgical repair, usually performed before 1-2 years of age
Hypospadias (more common than epispadias) is when the urethra opens onto the bottom (underside) of the penile shaft Patient with hypospadias will present as → a healthy newborn male is undergoing routine examination. Upon examination of the genitalia, the urethral meatus is found located proximal to the tip of the glans on the ventral aspect (underside) of the penile shaft.
DX: Diagnosis is usually made during the newborn exam, but imaging studies (excretory urogram) can aid in the diagnosis TX: Treatment is surgical repair, usually performed before 1-2 years of age
|
Paraphimosis/phimosis | ReelDx Virtual Rounds (Paraphimosis) Patient will present as → a 31-year-old male who presents to the ED with penile pain after intercourse. He states that his penis is swollen and very painful. His vital signs are normal. The physical exam is notable for edematous foreskin that does not reduce to its original position. Paraphimosis is an inability to return the foreskin to its normal position
DX: The diagnosis of paraphimosis is based on clinical findings TX: Treat by applying firm circumferential compression to the glans with the hand - may relieve edema sufficiently to allow the foreskin to be restored to its normal position.
Patient will present with → foreskin in normal position that cannot be retracted. Phimosis is an inability to retract the foreskin
DX: The diagnosis of paraphimosis is based on clinical findings TX: Treat with betamethasone topically. If there is no improvement - circumcision |