Penis Conditions

Hypospadias

This is a developmental condition where the urethra opens on the under surface of the penis shaft, rather than the tip of the glans.

It occurs when the urethral folds fail to close.

Management

Surgical correction is the definitive treatment

Epispadias

This is a developmental condition where the urethra opens on the upper surface of the penis shaft, rather than tip of the glans.

It can be due to wrong positioning of the genital tubercle.

Management

Surgical correction

Balanitis

This is acute inflammation of the foreskin and glans, usually due to infection

Can also be due to systemic conditions, so important to note whether there is itching/discharge

Key tests

If suspected infection, take a swab for culture to grow the pathogen

Management

General cleaning, e.g., saline wash

Antibiotics are indicated for positive swab results

1% hydrocortisone (steroid) cream can be used]

Phimosis

This refers to when the foreskin covers the external urethral meatus.

It is usually asymptomatic but can cause glans inflammation resulting in painful intercourse as well as an increased risk of infection and ulceration.

Management

Treat if causing complications, may require surgical correction

Paraphimosis

This can occur when a tight foreskin is pulled over the glans. The foreskin may become irreplaceable, compressing the glans which leads to ischaemia.

It can occur if you fail to put back the foreskin after inserting a urinary catheter.

Management

Ask the patient to squeeze the glans so foreskin can be replaced

If unresolving, may require circumcision

Condyloma Acuminatum

This refers to benign warts on the genital skin.

They are usually pink in colour and can be painful

Often due to HPV type 6/11, giving genital warts

Management

Physical ablation (cryotherapy) or topical agents