Urethritis is inflammation of the urethra that is usually caused by a sexually transmitted infection like chlamydia or gonorrhea. It can cause symptoms like burning with urination, urethral discharge, and dysuria. Diagnosis involves tests like gram stains and cultures of urethral discharge. Treatment depends on the causative organism but commonly involves antibiotics like azithromycin or doxycycline. Complications can include prostatitis, epididymitis, and infertility if left untreated.

1. CREATED BY : MRS . PALLAVI CHAUHAN
CONDITIONS OF THE MALE REPRODUCTIVE
TRACT

2. CONDITIONS OF THE MALE
REPRODUCTIVE TRACT
URETHRITIS
• Urethritis is inflammation of the urethra. It is
usually an ascending infection in men. In
women, it is usually associated with cystitis
(see page 779) or vaginitis

3. • Pathophysiology and Etiology
• Nongonococcal urethritis—urethritis not caused by gonococcus;
however, a large number of cases are sexually transmitted by:
– Chlamydia trachomatis—most clinically significant of the pathogens,
accounts for 23% to 55% of cases.
– Ureaplasma urealyticum and Mycoplasma genitalium—responsible for up to
one third of cases.
– Trichomonas vaginalis and herpes simplex virus are other sexually transmitted
organisms causing urethritis in men and women.
– Incubation period of 1 to 5 weeks depending on the organism; in some cases,
infection may be subclinical for a period of time, particularly in men.
• Gonococcal urethritis—caused by Neisseria gonorrhoeae, sexually
transmitted; usually most virulent and destructive.
– Incubation period usually 3 to 10 days.
– Urethritis in homosexual men is more commonly gonococcal than
nongonococcal.
• Gonococcal and nongonococcal urethritis can be present.
• Nonsexually transmitted.
– Bacterial urethritis—may be associated with UTI.
– From trauma—secondary to passage of urethral sounds, repeated
cystoscopy, indwelling catheter.

4. Clinical Manifestations
• Usually asymptomatic
• Itching and burning around area of urethra
• Urethral discharge: may be scant or profuse;
thin, clear, or mucoid; or thick and purulent
(gonococcal)
• Dysuria and frequency
• Penile discomfort

5. Diagnostic Evaluation
• Gram stain—N. gonorrhoeae is detected as gram-positive
diplococci on microscopic examination of urethral
discharge or urine.
• Culture of urethral discharge on selective medium.
• DNA amplification tests on urethral voided specimen or
other DNA/antibody tests of urethral discharge—to detect
C. trachomatis and N. gonorrhoeae.
• Wet mount microscopic examination of fresh urethral
discharge—trichomonads may be visible and motile.
• First voided urine for screening—either positive leukocyte
esterase test by dipstick or greater than 10 WBC per high-
power field by microscopy indicates urethritis.
• In rare cases, urethroscopy may be necessary to isolate a
lesion such as warts caused by human papillomavirus
(HPV).

6. • Management
• Gonococcal urethritis: one dose oral antibiotic of cefixime
(Suprax) 400 mg, ciprofloxacin (Cipro) 500 mg, ofloxacin
(Floxin) 400 mg, or levofloxacin (Levaquin) 250 mg; one
dose I.M. treatment with ceftriaxone (Rocephin) 125 mg.
• Nongonococcal urethritis or confirmed chlamydial
urethritis: single dose of oral antibiotic azithromycin
(Zithromax) 1 g of doxycycline (Vibramycin) 100 mg orally
twice per day for 7 days.
• Unless proved otherwise by negative testing, treatment for
chlamydia is given along with treatment for gonorrhea.
• Recurrent urethritis despite appropriate treatment for
nongonococcal urethritis or confirmed presence of T.
vaginalis: one dose oral metronidazole (Flagyl) 2 gm plus
erythromycin 500 mg orally four times per day for 7 days.

7. Complications
• Depends on cause, but may include:
• Prostatitis, epididymitis, urethral stricture,
sterility due to vas epididymal duct obstruction.
• Rectal infection, pharyngitis, conjunctivitis, skin
lesions, arthritis with gonococcal infection.
• Long-term complications of these infections in
women include pelvic inflammatory disease and
infertility.

8. ENURESIS – bed wetting
Definition
Repeated involuntary urination after age 5
Primary enuresis: the child has never achieved complete bladder control. Child is
not able to sense a full bladder and does not awaken to void
Secondary or acquired enuresis: child achieves bladder control. It can be
nocturnal or diurnal
Nocturnal enuresis: occurs when child is sleeping

9. Causes
Stress: birth of sibling, moving to a new home
Incomplete muscle maturation
Altered sleep pattern
Irritable bladder that can’t handle large amount of urine
 medical problem like diabetes, sickle-cell anemia, or epilepsy.
 Snoring and episodes of interrupted breathing during sleep (sleep
apnea) occasionally contribute to bed-wetting problems.
 Enlarged adenoids
 urinary tract infection, severe constipation, or spinal cord injury

10. Pathophysiology
Child sleeps too soundly
Child may have smaller blader capacity
Complications
Low self esteem
Social withdrawal
Anger, rejection and punishment by caregivers

11. Assessment
•Routine physical examination
•Determine age of toilet training, onset of enuresis and frequency of occurrences
•Functional bladder capacity . Ability to hold night’s urine is probable when
functional bladder capacity reaches 300 ml
•Urinalysis, C/S- infection
•Blood studies: BUN, creatinine

12. MX
Behavior modification.
This method of therapy is aimed at helping children take responsibility for their
night-time bladder control by teaching new behaviours. For example, children are
taught to use the bathroom before bedtime and to avoid drinking fluids after
dinner. While behaviour modification generally produces good results, it is long-
term treatment.

13. •Alarms.
•This form of therapy uses a sensor placed in the child's pajamas or in a bed
pad. This sensor triggers an alarm that wakes the child at the first sign of
wetness. If the child is awakened, he or she can then go to the bathroom and
finish urinating. The intention is to condition a response to awaken when the
bladder is full. Bed-wetting alarms require the motivation of both parents and
children. They are considered the most effective form of treatment now
available.

14. HYPOSPADIAS
A congenital anomaly of the penis in which the urethral meatus opens on the ventral
surface (underside ) of the penis
EPISPADIAS
The urinary meatus opens on the dorsal surface (top side of the penis
Both conditions shorten the distance to the bladder, offering bacteria easier access
Causes
Genetic factors
Possibly caused by decreased testosterone production in early gestation

15. On ventral surface

16. Assessment
•Altered angle of urination
•Normal urination with penis elevated is impossible because of chordee
a band of fibrous tissue causing penis curvature
•Epispadias often related to bladder extrophy
it occurs from the failure of the abdominal wall and its underlying structures to fuse
in uterus
•The anterior surface of bladder lies open on the lower side of abdomen allowing
constant passage of urine to the outside

17. Bladder extrophy

18. MX
Hypospadias
Avoid circumcision ( the foreskin may be needed later for surgical repair)
No treatment is necessary in mild disorder
Meatotomy
A surgical procedure performed to extend the urethra into a normal position
Surgery to release the chordee
performed when the child is 12 to 18 months old
if extensive repair is needed, surgery is delayed until age 4

19. Post op MX
Analgesics: tylenol
Antispasmodics: probanthine
Keep the area clean
Use a pressure dressing to reduce bleeding and tissue swelling
Keep the child’s hand away from penis
Check the tip of penis frequently
Avoid pressure or kinking of catheter

20. • EPIDIDYMITIS
• Epididymitis is an infection of the epididymis
that usually spreads from the urethra or
bladder to the epididymis by way of the
ejaculatory duct and vas deferens

21. Epispadias
Surgery requires multiple procedures
Associated bladder extrophy is closed preferably within the first few days of life
Ileal conduit
Cutaneus ureterostomy
The second phase of surgery involves the lengthening and straightening of the penis
and the creation of a more distal urethral opening

22. Pathophysiology and Etiology
• Occurs as a complication of UTI, urethral stricture
disease, bacterial prostatitis, gonococcal or
nongonococcal bacterial urethritis.
• In men under age 35, sexually transmitted organisms
are the main etiologic agents, usually C. trachomatis
and N. gonorrhoeae.
• In homosexual men, E. coli is a common cause.
• In older men, the main causes are bladder outlet
obstruction and urinary bacteria (E. coli, P. aeruginosa).

23. Clinical Manifestations
• Unilateral scrotal pain and tenderness
• Edema, redness, and tenderness of scrotum
• Dysuria, frequency
• Fever, nausea, vomiting
• Pyuria, bacteriuria, leukocytosis

24. Diagnostic Evaluation
• Examination (Gram stain, culture) of initial and
midstream urine sample to detect bacteria
• Examination (Gram stain, culture, gonorrhea
and Chlamydia testing) of urethral discharge
and expressed prostatic secretions to establish
causative organism

25. • Management
• Antimicrobial therapy after collection of specimens.
– Treatment of choice for presumed sexually transmitted
infections is combination ceftriaxone (Rocephin) 250 mg
I.M. in a single dose with doxycycline 100 mg orally twice
per day for 10 days.
– For presumed E. coli and other infections, a quinolone
such as ofloxacin (Floxin) 300 mg orally twice per day for
10 days is recommended.
• Analgesics for pain relief.
• Bed rest with the scrotum elevated on a towel to allow
for lymphatic drainage.
• In some cases, the spermatic cord is injected with a
local anesthetic to relieve pain.

26. Complications
• Spread of infection to testicle—epididymo-
orchitis
• Infertility; risk is greater when bilateral
infection

27. Cryptorchidism/ Undescended testicle
Failure of one or both testes to descend through the inguinal canal to the normal
position in the scrotum
Pathophysiology
•Etiology: mechanical lesion, endocrine disorder , delayed descent
•Testicular and ductal development are abnormal
•Degeneration of the sperm forming cells occurs after puberty because of the higher
temperature of the abdomen as compared to scrotum
•Testes remain in abdomen, in the inguinal canal, or at the external ring

29. S/S
Testicle nonpalpable within the scrotum
DX
Ultrasonography
Serum testosterone may be decreased
TX
Monitor during first 12 months for spontaneous descent
Orchiopexy: surgery to achieve permanent fixation of the testis in the scrotum
between 1-3 years of age
Monitor for bleeding and infection postoperatively
HCG administration- stimulates production of testosterone

31. Complication
•Testicular torsion
•Associated hernias
•Emotional disturbance
•Sterility
•Malignancy

33. PROSTATITIS
• Prostatitis is an inflammation of the prostate
gland. It is classified as bacterial
prostatitis(acute or chronic), nonbacterial
prostatitis, or prostatodynia.

34. Pathophysiology and Etiology
• Acute and Chronic Bacterial Invasion of Prostate
• From reflux of infected urine into ejaculatory and prostatic ducts
• From hematogenous (bloodstream) origin, lymphogenous spread,
or direct extension from the rectum
• Secondary to urethritis—from ascent of bacteria from urethra
• May be stimulated by urethral instrumentation or rectal
examination of the prostate when bacteria are present
• May be caused by gram-negative enteric bacteria such as
Pseudomonas aeruginosa, E. coli, Klebsiella pneumoniae and gram-
positive cocci, such as Streptococcus and Staphylococcus. May also
be caused by Chlamydia trachomatis.

35. Nonbacterial Prostatitis
• The cause is unknown, may be trichomonas,
Ureaplasma, or other organism.
• No bacterial cause may be identified.
• Prostatodynia
• Pain or discomfort without other signs of
infection and no known etiologic cause;
difficult to diagnose and manage.

36. Clinical Manifestations
• Sudden chills and fever (moderate to high fever) and
body aches with acute prostatitis.
• Symptoms are more subtle with chronic prostatitis and
nonbacterial prostatitis.
• Bladder irritability—frequency, dysuria, nocturia,
urgency, hematuria to varying degrees.
• Pain in perineum, rectum, lower back, lower abdomen,
and penile head.
• Pain after ejaculation, symptoms of urethral
obstruction.

37. • Diagnostic Evaluation
• Culture and sensitivity tests of divided urine specimens.
– First 10 to 15 mL voided after cleaning are sent as urethral
specimen.
– Next 50 to 75 mL of urine are collected as bladder specimen.
– Prostate is massaged, and either prostatic fluid drips out by
gravity and is collected, or patient voids urine mixed with
prostatic fluid.
– In acute bacterial prostatitis there will be numerous WBC and
positive culture of the third specimen; lower bacterial colony
count in chronic prostatitis; WBC but negative culture in
nonbacterial prostatitis.
• Rectal examination commonly reveals exquisitely tender,
painful, swollen (boggy) prostate, warm to the touch with
acute prostatitis.
• Serum WBC count is elevated in bacterial prostatitis.

38. Management, Acute Bacterial Prostatitis
• Antimicrobial therapy generally for 30 days based on
drug sensitivity; commonly co-trimoxazole (Bactrim,
Septra) or a fluoroquinolone.
• I.V. therapy with ampicillin or an aminoglycoside in the
hospitalized patient. Patients are hospitalized if there is
suspected abscess, urosepsis, or immunocompromise.
• Urinary retention is managed with suprapubic
cystostomy; urethral catheterization should be
avoided.
• Antipyretics, analgesics, hydration, and sitz baths for
symptom relief.

39. Chronic Bacterial Prostatitis
• Usually 3 months of oral antibiotic therapy
with ability to diffuse into prostate.
– Quinolones, such as ciprofloxacin (Cipro),
ofloxacin (Floxin), or norfloxacin (Noroxin).
– Sulfonamide such as co-trimoxazole (Bactrim).
• Oral antispasmodic agents may provide relief
from urinary frequency and urgency.

40. Nonbacterial Prostatitis
• One to 2 weeks of oral antibiotics, including tetracycline (Sumycin),
doxycycline (Vibramycin), or erythromycin (PCE)
• Symptomatic relief
– Prostatic massage (not for acute prostatitis)
– Anticholinergics to relieve spasm or anti-inflammatory drugs to relieve
inflammation
– Hot sitz baths for comfort and to promote penetration of the antibiotic
Prostatodynia
• Alpha-adrenergic blockers and skeletal muscle relaxants may
provide some relief of symptoms. Aggressive diagnostic
intervention should take place to rule out other conditions, such as
cancer of the prostate or interstitial cystitis.

41. BENIGN PROSTATIC HYPERPLASIA
• Benign prostatic hyperplasia (BPH) is
enlargement of the prostate that constricts
the urethra, causing urinary symptoms. One of
four men who reach the age of 80 will require
treatment for BPH

42. Pathophysiology and Etiology
• The process of aging and the presence of circulating
androgens are required for the development of BPH.
• The prostatic tissue forms nodules as enlargement
occurs.
• The normally thin and fibrous outer capsule of the
prostate becomes spongy and thick as enlargement
progresses.
• The prostatic urethra becomes compressed and
narrowed, requiring the bladder musculature to work
harder to empty urine.
• Effects of prolonged obstruction cause trabeculation
(formation of cords) of the bladder wall, decreasing its
elasticity.

43. Clinical Manifestations
• In early or gradual prostatic enlargement, there
may be no symptoms because the bladder
musculature can initially compensate for
increased urethral resistance.
• Obstructive symptoms—hesitancy, diminution in
size and force of urinary stream, terminal
dribbling, sensation of incomplete emptying of
the bladder, urinary retention.
• Irritative voiding symptoms—urgency,
frequency, nocturia.

44. Diagnostic Evaluation
• American Urologic Association Symptom Index score > 7 (uses
rating of questions about the obstructive and irritative symptoms)
• Rectal examination—smooth, firm, symmetric enlargement of the
prostate
• Urinalysis to rule out hematuria and infection
• Serum creatinine and BUN—to evaluate renal function
• Serum PSA—to rule out cancer, but may also be elevated in BPH
• Optional diagnostic studies for further evaluation:
– Urodynamics—measures peak urine flow rate, voiding time and
volume, and status of the bladder's ability to effectively contract
– Measurement of postvoid residual urine; by ultrasound or
catheterization
– Cystourethroscopy—to inspect urethra and bladder and evaluate
prostatic size

45. Management
• Patients with mild symptoms (in the absence of significant bladder or
renal impairment) are followed annually; BPH does not necessarily worsen
in all men.
• Pharmacologic management
– Alpha-adrenergic blockers, such as doxazosin (Cardura), tamsulosin (Flomax),
terazosin (Hytrin)—relax smooth muscle of bladder base and prostate to
facilitate voiding.
– Finasteride (Proscar)—antiandrogen effect on prostatic cells, reverses or
prevents hyperplasia
• Surgery—TURP, transurethral incision of the prostate, or open
prostatectomy for very large prostates, usually by suprapubic approach
• Newer approaches—laser surgery, transurethral electrovaporization,
transurethral needle ablation, insertion of intraurethral stents,
hyperthermia, and thermotherapy

46. GENITAL LESIONS CAUSED BY SEXUALLY
TRANSMITTED DISEASES
• Genital lesions are ulcerations or other skin or
mucous membrane lesions that indicate
infection with an STD and may actively shed
the infecting organism.

47. Pathophysiology and Etiology
• Causes include:
• Syphilis—Treponema pallidum
• Chancroid—Haemophilus ducreyi
• Lymphogranuloma venereum—specific subtypes
of C. trachomatis
• Genital herpes—herpes simplex virus
• Condylomata acuminata (genital
warts)—specific subtypes of HPV

48. Clinical manifestation
• Herpes genitalis
2-7 days
• Clustered vesicles on erythematous,
edematous base that rupture leaving shallow,
painful ulcer that eventually crusts; mild
regional lymphadenopathy; recurrent and may
be brought on by stress, infection, pregnancy,
sunburn.

49. Diagnosis & treatment
• Diagnostic tests include Tzank smear, viral
culture, or antigen test of tissue or exudate
from lesion.
• No cure, but symptomatic period is
diminished by acyclovir (Zovirax) or other
antiherpetic started with each recurrence; or
recurrences greatly reduced or prevented by
continuous treatment.
• Analgesics and sitz baths promote comfort

50. • Syphilis
10-90 days for primary; up to 6 months following
lesion (chancre) for secondary
• Primary:Nontender, shallow, indurated, clean
ulcer; mild regional lymphadenopathy.
Secondary:Maculopapular rash including palms
and soles, mucous patches, and condylomatous
lesions; fever, generalized lymphadenopathy

51. Diagnosis and treatment
• Venereal Disease Research Laboratory test or
rapid plasma reagin blood test with
confirmation by specific treponemal antibody
tests.
• Preferred treatment is benzathine penicillin G
(Bicillin L-A) 2.4 million units intramuscularly
(I.M.) in a single dose; doxycycline
(Vibramycin), tetracycline (Tetracyn), and
possibly erythromycin (Eryc) may be used.

52. • Chancroid
2-10 days
• Vesiculopustule that erodes, leaving a tender,
shallow or deep, well-circumscribed ulcer with
ragged, undermined borders and a friable
base covered by purulent exudate; unilateral
or bilateral large, tender inguinal lymph nodes
(buboes) in 50% of patients

53. Diagnostic & treatment
• May be identified on Gram, Giemsa, or Wright
stain; must be cultured on special media.
• Treated with azithromycin (Zithromax),
erythromycin (Eryc), or ceftriaxone (Rocephin)
I.M. Single-dose regimens are available.
• Apply warm soaks to buboes.

54. Patient Education and Health Maintenance
• Explain transmission of STDs and preventive measures,
such as male or female condoms, abstinence, and mutual
monogamy.
• Encourage compliance with treatment regimen and follow-
up to ensure cure before resuming sexual activity.
• Explain that some shedding of herpes virus may occur even
while asymptomatic, so patient must discuss this with
partner; consider use of condoms at all times; and reduce
risk P.804
•
of transmission by abstaining at the first sign of an outbreak
(tingling sensation) until 1 to 2 weeks after resolution of
symptoms

55. CANCER OF THE PROSTATE
• Cancer of the prostate is the second-leading cause of cancer death
among American men and is the most common carcinoma in men
over age 65.
• Pathophysiology and Etiology
• The incidence of prostate cancer is 30% higher in black men.
• The majority of prostate cancers arise from the peripheral zone of
the gland; therefore, most prostatic cancers are palpable on rectal
examination.
• Prostate cancer can spread by local extension, by lymphatics, or by
way of the bloodstream.
• The etiology of prostate cancer is unknown; there is an increased
risk for persons with a family history of the disease.
• The influences of dietary fat intake, serum testosterone levels,
vasectomy, and industrial exposure to carcinogens are under
investigation.

56. Clinical Manifestations
• Most early-stage prostate cancers are asymptomatic.
• Symptoms due to obstruction of urinary flow:
– Hesitancy and straining on voiding, frequency, nocturia
– Diminution in size and force of urinary stream
• Symptoms due to metastasis:
– Pain in lumbosacral area radiating to hips and down legs (from
bone metastases)
– Perineal and rectal discomfort
– Anemia, weight loss, weakness, nausea, oliguria (from uremia)
– Hematuria (from urethral or bladder invasion, or both)
– Lower extremity edema—occurs when pelvic node metastases
compromise venous return

57. • Diagnostic Evaluation
• Digital rectal examination—prostate can be felt through the wall of
the rectum; hard nodule may be felt (see Figure 21-10).
• Needle biopsy (through anterior rectal wall or through perineum)
for histologic study of biopsied tissue, includes Gleason tumor
grade if carcinoma present.
• Transrectal ultrasonography—a sonar probe placed in rectum.
• PSA—serologic marker of prostate cancer.
– Suspicion of prostate cancer if it measures between 4.0 and 10 ng/mL;
however, prostate cancer may also occur at levels under 4.0.
– Most PSA measurements over 10 ng/mL indicate prostate cancer.
– A free PSA level can be used to help stratify the risk of an elevated
PSA.
• Staging evaluation—skeletal X-rays, CT scan, MRI, bone scan,
analysis of pelvic lymph nodes provide accurate staging information

58. • Management
• Conservative Measures
• No treatment may be indicated in men over age 70 because prostate
cancer may be slow growing and it is expected that many men will die
from other causes. It is commonly recommended that these patients be
followed closely with periodic PSA determinations and examination for
evidence of metastases.
• Symptom control for advanced prostatic cancer in which treatment is not
effective:
– Analgesics and opioids to relieve pain.
– Short course of radiotherapy for specific sites of bone pain.
– I.V. administration of beta-emitter agent (strontium chloride 89) delivers
radiotherapy directly to sites of metastasis.
– TURP to remove obstructing tissue if bladder outlet obstruction occurs.
– Suprapubic catheter placement

59. Surgical Interventions (Curative)
• Radical prostatectomy—removal of entire prostate
gland, prostatic capsule, and seminal vesicles; may
include pelvic lymphadenectomy.
– Procedure is used to treat stage A and B prostate cancers.
– Complications include urinary incontinence and
impotence, possible rectal injury.
– Newer nerve-sparing techniques may preserve sexual
potency and continence.
• Cryosurgery of the prostate freezes prostate tissue,
killing tumor cells without removing the gland.

60. • Radiation (Curative)
• External beam radiation (using linear accelerator) focused on the
prostate—to deliver maximum radiation dose to tumor and
minimal dose to surrounding tissues.
• Interstitial radiation—interstitial implantation of radioactive
substances (brachytherapy) into prostate, which delivers doses of
radiation directly to tumor while sparing uninvolved tissue.
• Used to treat stages A, B, and C, especially if patient is not good
surgical candidate. Both forms of radiation are used in some
patients; external beam followed by brachytherapy.
• Complications include radiation cystitis (urinary frequency, urgency,
nocturia), urethral injury (stricture), radiation enteritis (diarrhea,
anorexia, nausea), radiation proctitis (diarrhea, rectal bleeding),
impotence, skin reaction, and fatigue.

61. • Hormone Manipulation (Palliative)
• Prostate cancer is a hormone-sensitive cancer. The aim of hormonal treatment is
to deprive tumor cells of androgens or their by-products and thereby alleviate
symptoms and retard progress of disease.
• Bilateral orchiectomy (removal of testes) results in reduction of the major
circulating androgen, testosterone. A P.800
•
small amount of androgen is still produced by adrenal glands.
• Pharmacologic methods of achieving androgen deprivation—also used to reduce
tumor volume before surgery or radiation therapy.
– Luteinizing hormone-releasing hormone (LHRH) analogues (leuprolide [Lupron], goserelin
acetate [Zoladex]) reduce testosterone levels as effectively as orchiectomy.
– Antiandrogen drugs (flutamide [Eulexin], bicalutamide [Casodex], nilutamide [Nilandron])
block androgen action directly at the target tissues (testes and adrenals) and block androgen
synthesis within the prostate gland.
– Combination therapy with LHRH analogues and an anti-androgen blocks the action of all
circulating androgen.

62. Complications
• Bone metastasis—vertebral collapse and
spinal cord compression, pathologic fractures
• Complications of treatment

63. CARCINOMA OF THE PENIS
• Carcinoma of the penis occurs primarily on
the glans of the penis; it is frequently
associated with poor personal hygiene and the
accumulation of smegma under the skin of an
uncircumcised penis. It primarily occurs in
men over age 60 and represents 0.5% of
malignancies in men in the United States.

64. Pathophysiology and Etiology
• Several types of penile lesions are potentially premalignant.
– Condylomata acuminata
РGiant condylomata acuminata (Buschke-L̦wenstein tumor)
– Kaposi's sarcoma
– Leukoplakia
• Erythroplasia of the glans (erythroplasia of Queyrat) is a carcinoma
in situ of the penis and may involve the glans, prepuce, penile shaft,
or may spread to the remainder of the genitalia and perineal
region.
• P.805
•
• Malignant lesions that ulcerate metastasize quickly to the regional
femoral and iliac lymph nodes.
• Distant metastasis occur in the inguinal lymph nodes; in rare cases
to lungs, liver, bone, or brain

65. Clinical Manifestations
• Disease process begins with a painless, wartlike
growth or ulcer on the glans, prepuce, or coronal
sulcus.
• Phimosis (constriction of foreskin with inability to
retract over glans) may obscure a lesion,
preventing detection until advanced stages.
• Lymphadenopathy; secondary infection of
lesions.

66. Diagnostic Evaluation
• Biopsy of penile lesion
• Ultrasonography and MRI of inguinal lymph
nodes
• Chest X-ray, CT scan (or MRI), bone scan to
assess for distant nodal metastases

67. Management
• Localized lesions are surgically removed by partial
penectomy, laser or cryotherapy or Mohs' micrographic
surgery; total penectomy with perineal urethrostomy is
necessary for more involved tumors.
• After other causes of lymphadenopathy are ruled out,
bilateral inguinal lymphadenectomy may be performed.
• Radiation therapy to small superficial tumors and lymph
nodes may control the disease.
Complications
• Disfigurement due to ulceration or treatment
• Complications of lymphadenectomy—necrosis and
infection of skin flap, chronic edema of lower extremities

68. Unit VI : Nursing management of patient (adults including elderly) with
disorders of genito-urinary problems
• • Review of anatomy and physiology of genitor-urinary system
• • Nursing Assessment-History and physical assessment
• • Etiology, Pathophysiology, clinical manifestations diagnosis, treatment
modalities and medical,
• surgical, dietetics & nursing management of
• • Nephritis
• • Nephrotic syndrome
• • Nephrosis
• • Renal calculus
• • Tumours
• • Acute renal failure
• • Chronic renal failure
• • End stage renal disease
• • Dialysis, renal transplant
• • Congential disorders, urinary infections
• • Benign prostate hypertrophy

69. • Disorders of ureter, urinary bladder and urethra-inflammation infection,
stricture obstruction,
• tumour, prostrate
• • Special therapies, alternative therapies
• • Nursing procedures Drugs used in treatment of genitourinary disorders