PANCE Blueprint Genitourinary (5%)

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

osmosis

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
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

Nephrolithiasis/urolithiasis (ReelDx + Lecture) (Prev Lesson)
(Next Lesson) Erectile dysfunction (Lecture)
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