Penile disorders

1. SUMANDEEP NURSING COLLEGE
SEMINAR ON DISORDERS OF MALE REPRODUCTIVESYSTEM
PRESENTEDBY NIKHIL VAISHNAV
FIRSTYEAR MS.CNURSING STUDENT

3. 1) Balanitis.
2) Phimosis.
3) Paraphimosis.
4) Priapism.
5) Peyronie’s disease.
6) Penile cancer.
7) Erectile dysfunction.

4.  Definition: It is an inflammation of the
glans or head of the penis.
 Incidence: It is a common condition
affecting 1 in every 25 boys.

5. 1. Candida albicans infections: It is a most
common cause.
2. Sexually transmitted infections (STIs).
3. Skin conditions can also trigger the
conditions includes Lichen planus ,
Eczema , Dermatitis and Psoriasis.
4. Irritants includes Chemicals used in
condoms, lubricants and spermicides lead
to inflammation of the glans.

6. 1) Phimosis.
2) Diabetes.
3) Unprotected sex.
4) Poor hygiene.
5) Having a urinary catheter.

7.  Tight, shiny skin on the glans
 Inflammation, soreness, itchiness, or
irritation of the glans
 A thick, lumpy discharge under the
foreskin
 An unpleasant smell
 Tight foreskin that cannot be pulled back
 Painful urination
 Sores on the glans

8.  History collection.
 Physical examination: Inspection of
the penile area.
 A blood test to determine blood
glucose level.
 A swab test to test for any infection.
 A urine test if diabetes is suspected.

9.  Allergic reaction: Mild steroid cream
such as 1% hydrocortisone.
 Yeast infection: Antifungal cream
such as Clotrimazole, Miconazole. The
patient’s sex partner should also be
treated.

10.  Bacterial infection: If there is a
bacterial infection, an antibiotic such
as penicillin, Erythromycin.
 Sitz bath .

11.  Introduction: Phimosis is defined as
inability to retract the foreskin or
prepuce of the penis.

12.  There are two types of Phimosis:
A. Congenital Phimosis.
B. Acquired Phimosis.

13.  Children are born with tight foreskin
at birth and separation occurs
naturally over time.
 Phimosis is normal for the
uncircumcised infant/child and usually
resolves around 5-7 years of age.

14.  Phimosis that occurs due to scarring,
infection or inflammation.

15.  Congenital defect.
 Yeast infection.
 Poor hygiene.
 Genetic.
 Due to loss of skin elasticity and
infrequent urination.
 Forceful retraction of the foreskin over
the glanspenis.

16.  Inability to fully retract the foreskin over the
glans
 Skin irritation
 Scarring of the foreskin and bleeding .
 Pain during urination.
 Hematuria.
 Painful erections
 Pain during sexual intercourse

17.  History collection.
 Physical examination.
 A swab from the foreskin area to rule
out bacterial infection.
 Urine test.
 Blood test.

18.  Congenital Phimosis may be
successfully treated by gentle
repeated stretching of the foreskin
over the glans.
 Treatment consists of Gentle daily
manual retraction.

19.  Topical corticosteroid ointment
includes hydrocortisone etc. ointment
is recommended for children with
Phimosis.
 It is an effective treatment in most
males.

20.  Circumcision: Circumcision is the
surgical removal of the foreskin of the
penis.
 It may be done for religious, culture
or hygienic reasons.
 It is done to prevent recurrence of
Paraphimosis.

21.  It is rare condition in which the
foreskin gets stuck in the retracted
position.
 Prepuce is retracted over the glans
and forms a constriction at the base of
the glans.

22.  When health care professional forgets
to pull back the foreskin after a
medical intervention or procedure. It
is most common causes of
Paraphimosis.

23.  Infection.
 Physical trauma to genitalia.
 More Tighter foreskin that normal.

24.  The main symptom of Paraphimosis is
the inability to return the foreskin
back to its normal position over the
tip of the penis.
 Swollen and painful foreskin.

25.  History collection.
 Physical examination: Inspection of
the penis. Ask about symptoms .

26.  The first step in management of
Paraphimosis is to reduce swelling .
Steps includes:
1. apply ice to the area
2. use needles to drain pus or blood
3. inject hyaluronidase.

27.  Second step : After reducing swelling doctor
gently move the foreskin back into position.
 Pain Killer is given at that time.

28.  A complete circumcision is necessary
in severe cases of Paraphimosis.

29.  Definition: Priapism a medical
condition in which the erect penis does
not return to its flaccid state.
 It occurs in the absence of both
physical and psychological stimulation,
within four hours.
 It is painful medical emergency.

30.  There are two types of Priapism .
1. Low flow (ischemic) Priapism: blood
not adequately returning to the body
from the penis. 80 – 90 % are low
flow types.
2. High flow ( Non ischemic) Priapism :
a short-circuit of the vascular system
pathway along the penis.

31.  The exact cause of Priapism is not fully
understood yet .

32. 1. Hematological disorders such as sickle
cell anemia, leukemia and thalesemia ETC.
2. neurologic disorders such as spinal cord
lesions and spinal cord trauma.
3. Intra-cavernous injections for treatment of
erectile dysfunction (papaverine,
alprostadil).
4. Others are antihypertensive,
antipsychotics.

33.  History collection.
 Physical examination.
 Diagnostic tests includes Blood tests,
Blood gas analysis, Doppler
ultrasonography.

34.  Treatment for Low flow Priapism :
1. Excess blood is drained from penis
by using needle and syringe(
Aspiration).
2. Medications: Phenylephrine.
3. Surgeon: As a last resort surgery is
performed.

35.  Non ischemic Priapism goes away without
treatment. Even though treatments are:
1) Putting icepacks and pressure on the
perineum.

36.  Definition: Peyronie’s disease, also
known as chronic inflammation of
the tunica Albuginea (CITA).
 It is a connective tissue disorder
characterized by the growth of fibrous
plaques in the soft tissue of the penis.

37.  Exact cause is unknown .
 Precipitating factors are:
1. Trauma or injury to the penis
through physical activity.
2. Trauma and injury through sexual
intercourse.

38. 1. Plaques formation.
2. Painful sexual intercourse,
3. Abnormal curvature of the penis.

39.  Medications: Collagenase
clostridium histolyticum .
 It is an FDA approved injectable drug
for treatment of Peyronie's disease.

40.  Nesbit operation- is considered a last
resort .
 The Nesbit operation, first used for
Peyronie’s disease in 1977, is still the
most common operation performed to
correct a penile curvature.

41.  Introduction: Penile cancer is a
malignant growth found on the skin or
in the tissues of the penis.

42.  Around 95% of penile cancers are
squamous cell carcinoma. Other types
are:
1. Merkel cell carcinoma.
2. small cell carcinoma.
3. Melanoma.

43. 1. HIV infection.
2. Human papilloma virus.
3. Genital warts.
4. Poor hygiene.
5. Phimosis.
6. Smegma: It is a white substance that can
accumulate beneath the foreskin.
7. Tobacco.

44.  Redness of the penis.
 Foul smelling discharge from the penis [.
 Pain in the penis.
 Warts or ulcer formation.
 Bleeding from the penis.
 Change in color of the penis.
 Phimosis.

45. Treatment includes surgery, radiation
therapy, chemotherapy, biological
therapy.

46.  Wide local excision : the tumor and
some surrounding healthy tissue are
removed
 Microsurgery: surgery performed with
a microscope is used to remove the
tumor .
 Laser surgery
 Circumcision.
 Amputation (penectomy).

47.  Definition: Impotence or Erectile
dysfunction is the inability of a man to have
an erection firm enough or sustain an
erection long enough for sexual
intercourse.
 ED or impotence is the inability to attain or
maintain an erect penis that allows
satisfactory sexual intercourse.

48.  The two fundamental causes of impotence
are physiological and psychological .

49.  Heart disease and narrowing of blood
vessels
 Diabetes.
 High blood pressure.
 High cholesterol
 Obesity and metabolic syndrome.
 Parkinson's disease .
 Multiple sclerosis .
 Smoking, alcoholism and substance abuse,
including cocaine use

50.  Depression .
 Stress , fear, anxiety, or anger
 Stress can include work, financial, and
emotional problems .
 Poor communication with a sex partner
 Other relationship problems such as
pressure from a sex partner .

51.  Inability to have an erection.
 Inability to sustain an erection.
 Inability to have an erection firm enough for
penetration.

52.  History collection regarding sexual history.
 Physical examination.
 CBC
 Urinalysis
 BUN.
 Fasting blood sugar.
 Hormonal studies.
 Arteriogram: Dye is injected to study blood
flow.
 Psychological test.

53.  Treatment of Erectile dysfunction includes
Medications and Physical therapy, counseling,
sexual therapy.

54.  Sildenafil (Viagra) .
 Topical Agents are occasionally used to
enhance venous congestion of the penis e.g.
Nitroglycerin ointments- topical vasodilator .
 Vasodialators are Papaverine and
pentolamine.


55.  Testosterone is used as hormonal
therapy . It induce libido.

56.  External vacuum devices are used to
achieve an erection for short time.

57.  Counseling and sexual therapy classes may
be suggested for patients who have
identified impotence.

58. 1. Vascular reconstructive surgery.
2. Inflatable prosthesis.
3. semi rigid prosthesis.