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Buschke –Löwenstein tumour The Buschke–Löwenstein tumour is uncommon. It has the histological pattern of a verrucous carcinoma. It is locally destructive and invasive but appears not to spread to lymph nodes or to metastasise. Treatment is by surgical excisio...

CARCINOMA OF THE PENIS Aetiology Circumcision soon after birth confers immunity against carci - noma of the penis. Later circumcision does not seem to have the same benefit, with the assumption that smegma is in some way carcinogenic. Infection with HPV types ...

Clinical features Many patients present late as a fungating/ulcerative growth ( Figure 85.24 ), either because of embarrassment or because of misdiagnosis. About 10% of patients are under 40 years of age. By the time the patient presents, the growth is ofte...

Condylomata acuminata (synonym:

Congenital anomalies Posterior urethral valves The incidence of posterior urethral valves is around 1 in 8000 live male births. The valves are membranes that have a small posterior slit within them. They typically lie just distal to the verumontanum and cause...

DISEASES OF THE FORESKIN Phimosis There are physiological adhesions between the foreskin and the glans penis at birth. They begin to disappear around the age of 2 years and may persist until 6 years of age or later, giving the false impression that the prepu...

FURTHER READING Kaisary A V , Ballaro A, Pigott K. Urology: lecture notes , 7th edn. Hoboken, NJ: Wiley-Blackwell, 2016. Wein AJ, Kavoussi LR, Partin AW , Peters CA. Campbell–Walsh urology , 12th edn. Amsterdam: Elsevier, 2020.

Fracture of the penis Fracture of the penis usually occurs when the erect penis is bent suddenly . It leads to rupture of the tunica albuginea with extravasation of blood from within the penis. Usually the patient feels a cracking or popping sound. It is as...

INFECTION AND INFLAMMATION OF THE PENIS AND URETHRA Fournier’s gangrene This is progressive infection of the genitalia and perineum ( Figure 85.25 ). It is usually caused by mixed bacterial flora ( Escherichia coli , Bacteroides spp., Streptococcus pyogenes , S...

INJURIES OF THE PENIS Avulsion of the skin of the penis Entanglement of clothing in rotating machinery and zip injuries are the usual causes. Partial injury to the penile skin can be repaired. Complete avulsion is treated by a two-stage procedure. Burying the...

Injuries to the male urethra Bulbar urethral trauma The patient usually gives a history of a falling-astride injury , leading to blunt trauma of the perineum. Other common causes include falling from a tree, cycling, skating and indus trial accidents. The bul...

CH A P T E R

Investigations A biopsy should be performed. MRI is performed for local staging. Assessment of locoregional lymph node status is essential.

Learning objectives To recognise and understand: The common congenital anomalies of the urethra • The diagnosis and treatment of urethral trauma • The diagnosis and treatment of urethral stricture •

Malignant melanoma of the penis This is an uncommon tumour with the principles of manage - ment being the same as for squamous cell carcinoma. Blood- borne metastatic disease is, however, more common.

Other abnormalities of the penis Erectile dysfunction ED is failure to attain or maintain an erection. It can arise as a consequence of psychological issues, but the commonest cause is vascular disease a ff ecting the penile arterial blood flow; as such, ED is ...

Other conditions of the urethra Urethral fistula This is seen after failed hypospadias surgery ( Figure 85.2e Tight strictures with periurethral abscess can present as multi ple fistulae (watering-can perineum). Urethral calculi Urethral calculi can arise primar...

Paraphimosis A tight foreskin once retracted may be di ffi cult to return and a paraphimosis results. In this condition, the venous and lymphatic return from the glans and distal foreskin is obstructed and these structures become oedematous, causing even more pr...