Urethra and Penis MCQs

This rarer form of priapism arises as a consequence of traumatic damage to the central penile artery, usually as a consequence of blunt perineal trauma. A fistula develops between the artery and the sinusoidal space, which results in a persistent erection that is painless, in contrast to the ischaemic priapism. Blood gas analysis shows the characteristics of arterial blood and Doppler scanning and selective arteriography will demonstrate the fistula. Treatment is not an emergency, since there is no ischaemia, and is most appropriately achieved by selective arterial embolisation. Reference : Bailey & Love's short practice of surgery 28th Edition, Chapter 85, Urethra and Penis, Pg: 1551.

Explanation: In infants and young boys, circumcision is most usually performed at the request of the parents for social or religious reasons . Medical indications for circumcision in boys include true phimosis , Balanitis xerotica obliterans (rare under the age of 5 years), recurrent attacks of balanoposthitis and recurrent urinary tract infections with an abnormal upper urinary tract . In adults, circumcision is indicated because of an inability to retract the foreskin for intercourse, for splitting of an abnormally tight frenulum or for recurrent balanitis.

Membranous urethra is located where the urethra penetrates the pelvic floor and it is the usual site of rupture at time of pelvic fracture. All other statements are correct. Reference : Bailey & Love's short practice of surgery 28th Edition, Chapter 85, Urethra and Penis, Pg: 1538.

Post Inflammatory strictures are less common since the introduction of effective antibiotic treatment of gonorrhoea. The stricture is most commonly seen in the bulbar urethra but submeatal strictures also occur. There is infection in the periurethral glands, which persists after inadequately treated gonorrhoea. The infection spreads to cause a periurethritis, which heals by fibrosis. Most strictures appear within 1 year of infection but may not cause difficulty in micturition for some time later. The common causes of urethral stricture are: lichen sclerosus (LS); iatrogenic (post catheter and/or instrumentation); sexually transmitted diseases (gonorrhoea); post radiation; traumatic; idiopathic; congenital. Reference : Bailey & Love's short practice of surgery 28th Edition, Chapter 85, Urethra and Penis, Pg: 1542.

This idiopathic condition, which was described by Fowler and Kirby, is associated with an abnormal myotonic discharge in the striated urethral sphincter that can be detected by sphincter electromyography. It is often associated with polycystic ovaries and causes urinary retention in women and should not be confused with a urethral stricture. Urethral dilatation is ineffective and the retention is best treated by intermittent self-catheterisation. There is some evidence that sacral neuromodulation can be effective Reference : Bailey & Love's short practice of surgery 27th Edition, Chapter 79, Urethra and Penis, Pg: 1485.

lschaemic priapism lschaemic or veno-occlusive priapism is the more common. It is due to venous congestion, with consequent thrombosis and ischaemia. The penis remains erect and becomes painful. This is a pathological erection and the glans penis and corpus spongiosum are not involved. The condition is most commonly seen as a side effect of medication, most notably antipsychotic medication and intracavernosal injections. It can also arise as a complication of hypercoagulable blood disorders such as sickle cell disease or leukaemia. A small proportion of cases are caused by malignant disease in the corpora cavernosa or the pelvis. Reference : Bailey & Love's short practice of surgery 28th Edition, Chapter 85, Urethra and Penis, Pg: 1551.

Circumcision soon after birth confers immunity against carcinoma of the penis. Later circumcision does not seem to have the same benefit, with the assumption that smegma is in some way carcinogenic. Human papillomavirus infection (HPV types 16 and 18) is a risk factor, as are BXO and smoking. Phimosis and chronic balanoposthitis are known to be contributory factors, and there are definite pre carcinomatous states including leukoplakia of the glans, which is similar to the condition seen on the tongue, and penile intraepithelial neoplasia (PeIN) Reference : Bailey & Love's short practice of surgery 28th Edition, Chapter 85, Urethra and Penis, Pg: 1551.

Here the primary lesion is T2 hence lymph node dissection becomes mandatory even if it is clinically N0. The best results are from immediate adjuvant lymph node dissection (5 year survival 83%) and the worst results are from surveillance and delayed lymphadenectomy (5 year survival 36%). Several studies have analyzed the survival of men undergoing early versus delayed lymphadenectomy according to pathologic evaluation of nodal status The best results were from immediate adjunctive lymph node dissection (83%), with the next best from immediate therapeutic lymphadenectomy (66%). The worst results were from the surveillance and delayed lymphadenectomy group (36%), in whom dissection was delayed until palpable nodes developed. Reference : Campbell-Walsh-Wein Urology 12th Edition, Pg: 1757.