Treatment in the early stages is laser removal of the growth A radical

Treatment in the early stages is laser removal of the

This preview shows page 17 - 18 out of 24 pages.

Treatment in the early stages is laser removal of the growth. A radical resection of the penis may be done if the cancer has spread. Surgery, radiation, or chemotherapy may be tried depending on the extent of the disease, lymph node involve- ment, or metastasis. PROBLEMS OF SCROTUM AND TESTES INFLAMMATORY AND INFECTIOUS PROBLEMS Skin Problems Th e skin of the scrotum is susceptible to a number of common skin diseases. Th e most common are fungal infections, derma- titis (neurodermatitis, contact dermatitis, seborrheic dermati- tis), and parasitic infections (scabies, lice). Th ese conditions involve discomfort for the patient but are associated with few severe complications (see Chapter 24 ). PROBLEMS OF THE PENIS Health problems of the penis are rare if STIs are excluded (see Chapter 53 ). Problems of the penis may be classi fi ed as congeni- tal, problems of the prepuce, problems with the erectile mecha- nism, and cancer. CONGENITAL PROBLEMS Hypospadias is a urologic abnormality in which the urethral meatus is located on the ventral surface of the penis anywhere from the corona to the perineum. Possible causes are hormonal in fl uences in utero, environmental factors, and genetic factors. Surgical repair of hypospadias may be necessary if it is associ- ated with chordee (a painful downward curvature of the penis during erection) or if it prevents intercourse or normal urina- tion. Surgery may also be done for cosmetic reasons or emo- tional well-being. PROBLEMS OF PREPUCE Problems of the prepuce in the United States are not common because circumcision has been a routine procedure for many male infants. Circumcision, the surgical removal of the foreskin of the penis, is a procedure done to male infants for religious or cultural reasons. Phimosis is a tightness or constriction of the foreskin around the head of the penis, making retraction di ffi cult ( Fig. 55-8 , A ). It is caused by edema or in fl ammation of the foreskin, usually associated with poor hygiene techniques that allow bacterial and yeast organisms to become trapped under the foreskin. Th e goal of treatment is to return the foreskin to its natural position over the glans penis through manual reduction. One strategy involves pushing the glans back through the prepuce by apply- ing constant thumb pressure while the index fi ngers pull the prepuce over the glans. Ice and/or hand compression on the foreskin, glans, and penis may be done before this technique to reduce edema. Topical corticosteroid cream applied two or three times daily to the exterior and interior of the tip of the foreskin may also be e ff ective. Paraphimosis is tightness of the foreskin resulting in the inability to pull it forward from a retracted position and pre- venting normal return over the glans. An ulcer can develop if the foreskin remains contracted ( Fig. 55-8 , B ). Paraphimosis can occur when the foreskin is pulled back during bathing, use of urinary catheters, or intercourse and is not placed back in the forward position. Replacement of the foreskin a ft er careful cleaning helps to prevent this condition. Treatment may include
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