Male Genital Problems

Male Genital Problems
PResentation by: Eric Quimbo

Anatomy
* Penis
o 3 cylindrical bodies
+ Corpus Cavernosum (2)
+ Corpus Spongiosum (1)
o Tunica albuginea
o Buck’s Fascia
* Testes
o Tunica albuginea
o Epididymis
o Tunica vaginalis
+ Torsion risk
# Lack of posterior fixation
+ Parietal portion
# Hydrocele

Physical Examination

* Well-lit, warm room
* Visual inspection
* Penis
* Scrotum
o Mass?
+ If present, carcinoma until proven otherwise
o Lie of the testes?
* Inguinal canal
* Prostate

Scrotum

* Scrotal Edema
* Scrotal Abscess
o Must differentiate if phlegmon in scrotal wall vs. intrascrotal organs
* Fournier Gangrene
o Polymicrobial, necrotizing infection of the perineal subcutaneous fascia.
o Painful, erythematous/edematous scrotum
o DM is risk factor
o Tx – aggressive fluid resus, broad spectrum antibiotic coverage, HBO
o Mortality 20 %

Penis

* Balanoposthitis
o Inflammation of glans and foreskin
o Recurrence – can be sole presenting sign of DM
o Treat type of infection, good hygeine, topical antifungals
* Phimosis
o Inability to retract foreskin
o Emergent if inability to void
o Tx - Definitive – circumcision, Consider topical steroids at tip QD x 4-6 weeks
* Paraphimosis
o Inability to reduce proximal edematous foreskin back to position
o True urologic emergency
o Tx – compress glans several mins, tight wrapping of glans with 2 inch bandage x 5 mins, small needle punctures, or dorsal incision of the band.
* Entrapment Injuries
o String, metal rings, wire
o Human hair
+ 2 – 5 y/o
+ Check with retrograde urethrogram (urethral integrity) and doppler (blood supply)
+ Not a sign of child abuse
* Fracture
o Tear/rupture of corpus caverosa/tunica albuginea
o Hx trauma during sexual activity
o “snapping sound”
o Check retrograde urethrogram
o Surgical indication
o Check XR….
Priaprism

* Urologic emergency
* Complications – urinary retention, impotence 35%
* Causes – anti-impotence meds (papaverine, PGE), anti-hypertensives (hydralazine, prazosin, CCB), psych (chlorpromazine, trazodone, thioridazine), sickle cell in children
* 2 types
o High flow (rare)– nonischemic, nonpainful, traumatic fistula between cavernosal artery & corpus cavernosum, dx with doppler, and treated with embolization
o Low flow – more common, more painful, dx by aspiration dark acidic intracavernosal blood
* Treatment
o Pain control
o Terbutaline 0.25 – 0.5 mg SC q20-30 mins as needed
o Pseudoephedrine 60 – 120 mg PO if within 4 hours
o If sickle cell – exchange transfusion
o Corporal aspiration

Testes and Epididymis
Prostate

* Acute prostatitis
Urethra

* Urethritis
* Urethral Structure
Urinary Retention
* H&P important
* Voiding history
o Problems with holding/initiating?
o Manner of the stream, complete or interrupted?
o Feeling of bladder emptiness afterwards?

Quiz Answers
Male Genital Problems.ppt