Urethra & Penis & Scrotum Disease (Lecture + Lab)

2 Q's Lecture , 1 Q Lab

Hypospadia

Urethral opening under shaft (ventral)

Epispadia

Urethral opening on top of shaft (dorsal)

Priapism

Congestion of the corpora cavernosa >4-6 hours

Peyronies Disease

Chronic fibrosis of the tunica albuginea , pain and abnormal curvature

Phimosis

Foreskin scarred and unable to retract

Paraphimosis

Forcible retraction of the foreskin which becomes trapped behind the glans

Urethritis etiology

Gonococcal = Gonorrhea , Nongonococcal = chlamydia (also mycoplasma, tricohomonas, e.coli)

Complications from urethritis

Ascending infection, infertility, reactive arthritis

Reactive Arthritis

Males 15-35;

GU infection chlamydia;

GI infection shigella, salmonella, campylobacter

Reactive Arthritis HLA

HLA-B27

Reactive Arthritis Classic Triad

Conjunctivitis/Uveitis/Arthritis “Cant See, Cant Pee, Cant Climb a Tree”

Balanitis

Nonspecific penile ulcer

Specific Ulcer Etiology: Chancre

Treponema Pallidum (Syphilis)

Specific Ulcer Etiology: Chancroid

Haemophilus Ducreyi

Specific Ulcer Etiology: Lymphogranuloma Venereum

Chlamydia Trachomatis

Specific Ulcer Etiology: Granuloma Inguinale

Klebsiella granulomatis

Chancre - Treponema Pallidum (Syphilis)

Chancroid - Haemophilus Ducreyi

HSVII

Granuloma Inguinale - Klebsiella granulomatis

Condyloma Acuminata

HPV6,11

Balanitis

Condyloma Acuminata

Condyloma Acuminata

Condyloma Acuminata

Koilocytes

Benign Neoplasms of the Urethra (2)

Papilloma and Adenoma

Malignant Neoplasm of the Urethra (1)

Urothelial Carcinoma (Adenocarcinoma very rare)

PeIN

PeIN

PeIN

PeIN

Bowenoid Papulosis - Better prognosis than PIN

PeIN vs Bowenoid Papulosis age range

PeIN >35 years old, Bowenoid Papulosis 20’s

Penile squamous cell carcinoma demographics

Asia, Africa, South America ; 40-70 yo ; not circumscribed ; smokes ; hx HIV, HPV, PeIN

Squamous cell carcinoma

Squamous cell carcinoma

Squamous Cell Carcinoma

SCC well differentiated

SCC poorly differentiated

SCC Lymphovascular Invasion

HPV associated SCC with p16 staining

Penile SCC lymph metastasis

Inguinal (early) iliac (late)

Scrotal Liposarcoma

Scrotal liposarcoma , well differentiated

Scrotal liposarcoma, dedifferentiated

Scrotal leiomyosarcoma

BPH

Prostate Carcinoma

PeIN

SCC