Penile disorders (PEARLS)
| Erectile dysfunction |
Occurs when a man can't get or keep an erection firm enough for sexual intercourse
- Psychological
- Organic causes include hypertension, neurological problems from diabetes, and hormonal dysfunction
- Medication side effects
- Nocturnal penile tumescence used to evaluate sleep erections
- Do not use with nitrates may cause hypotension
Treat with phosphodiesterase 5 inhibitors Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra)
- Weight loss, smoking and alcohol cessation, hormone replacement and vacuum erection devices, and surgery
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| Hypospadias/epispadias |
Epispadias is when the urethra opens onto the topside of the penile shaft
- The position of the urethral meatus defines the type of epispadias
- Penopubic - at the base of the penis and abdominal wall come together (most severe)
- Penile - along the shaft of the penis
- Glanular - near the head of the penis (lease severe)
- Diagnosis is usually made during the newborn exam but imaging studies (excretory urogram) can aid in the diagnosis
Treatment is surgical repair, usually performed before 1-2 years of age
- Do not circumcise - foreskin may be used to reconstruct urethra
Hypospadias (more common than epispadias) is when the urethra opens onto the bottom (underside) of the penile shaft
- The position of the urethral meatus defines the type of hypospadias
- Glanular - head of the penis (lease severe)
- Midshaft - middle of the penis
- Penalscrotal - where the penis and scrotum come together (most severe)
- Diagnosis is usually made during the newborn exam but imaging studies (excretory urogram) can aid in the diagnosis
Treatment is surgical repair, usually performed before 1-2 years of age
- Do not circumcise - foreskin may be used to reconstruct urethra
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| Paraphimosis/phimosis |
Paraphimosis is an inability to return the foreskin to normal position
- Entrapment of the foreskin behind glans
- Causes a tourniquet effect and is a medical emergency
- More acute than phimosis
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.
- If this technique is ineffective, a dorsal slit using local anesthetic relieves the condition temporarily
- Circumcision is then done when edema has resolved.
Phimosis is an inability to retract the foreskin
- Usually resolves by age five
- Unable to retract the foreskin
- More chronic than paraphimosis
Treat with betamethasone topically, if no improvement circumcision |
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