🔑 Key Learning

  • Peyronie’s disease presents with painful curvature of the penis.
  • Priapism is a urological emergency if ischaemic (low-flow).
  • Paraphimosis requires urgent reduction to avoid necrosis.
  • Phimosis is physiological in young boys but may need steroids or circumcision if symptomatic.
  • Epididymal cysts and hydroceles are benign and often painless.
  • Varicoceles are typically left-sided; right-sided = red flag.

🌀 Peyronie’s Disease

🧬 Pathophysiology

  • Fibrosis of the tunica albuginea → acquired penile curvature

👀 Clinical Features

  • Penile curvature and shortening
  • Painful erections (esp. first 12–24 months)
  • Erectile dysfunction

💊 Management

  • Sildenafil for ED
  • Surgery to reduce curvature in persistent cases

🍌 Priapism

🧬 Pathophysiology

  • High-flow (non-ischaemic) – unregulated arterial inflow (e.g. trauma)
  • Low-flow (ischaemic) – venous outflow obstruction (e.g. sickle cell)

👀 Clinical Features

TypePainful?RigidityCommon Causes
High-flowNoPartialTrauma, spinal injury
Low-flowYes (ischaemia)FullSickle cell, injections

🧪 Investigations

  • Corporal blood gas:
    • High-flow: PO₂ > 9, CO₂ < 4.5
    • Low-flow: PO₂ < 3, CO₂ > 6, ↑ lactate

💊 Management

  • Initial: Corporal aspiration, analgesia
  • Phenylephrine intracavernosal injection
  • Surgery: shunt formation if refractory

🪢 Paraphimosis

  • The inability to pull forward a foreskin, that has already been retracted over the glans
  • Once occurred, the paraphimosis reduces venous return from the distal penis and glans, resulting in progressive oedema - eventually can result in penile ischaemia and necrosis 

👀 Clinical Features

  • Common post-catheterisation where foreskin was not retracted
  • Painful, swollen glans with tight, retracted foreskin
  • Can → ischaemia & necrosis

💊 Management

  • Manual reduction after analgesia
  • Surgical (dorsal slit or circumcision) if manual fails

🔄 Phimosis

📌 Background

  • Inability to retract foreskin
  • Normal in young boys – usually resolves with age

👀 Clinical Features

  • Ballooning of foreskin on micturition
  • Spraying urine stream
  • Pain during intercourse (adults)

💊 Management

  • If persistent, trial topical steroids
  • Circumcision if persistent/symptomatic

💦 Epididymal Cysts

🧬 Pathophysiology

  • Fluid-filled cyst in epididymis
  • Spermatocele = cyst containing sperm

👀 Clinical Features

  • Soft, smooth mass separate from testis
  • Classically at upper pole

🧪 Investigation

  • USS confirms diagnosis

💧 Hydrocele

🧬 Pathophysiology

  • Fluid accumulation within tunica vaginalis

👀 Clinical Features

  • Painless, fluctuant scrotal swelling
  • Transilluminates, testis palpable within

🧪 Investigation

  • USS

💊 Management

  • Usually conservative

🪰 Varicocele

🧬 Pathophysiology

  • Dilated pampiniform plexus → scrotal venous congestion
  • 90% are left-sided

👀 Clinical Features

  • Scrotal mass with "bag of worms" texture
  • Worse standing, improves lying down
  • Associated with subfertility

🧪 Investigation

  • USS Doppler

📋 Red Flags

  • Majority occur on the left. Therefore right-sided varicocele → suspect RCC
  • Sudden onset or tense lying down → urgent referral

💊 Management

  • Conservative unless symptomatic
  • Surgical referral if painful or persistent

📝 Exam Clues & Clinchers

  • Painful sustained errection + sickle cell = low flow priapism = urological emergency
  • Paraphimosis = urgent manual reduction
  • Hydrocele = transilluminates
  • Epididymal cyst = separate from testis
  • Varicocele right-sided = bag of worms
  • Peyronie’s = painful curvature in middle-aged man