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Pediatric Surgery (Pg 68-81) - page 29 / 33

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2 corpora cavernosa surrounded by tunica albuginea.

1 corpus spongiosum – encloses urethra

Both covered by Bucks fascia and skin

Arterial:internal pudendal – internal iliac venous: iliac veins

Trauma:

Possibility of urethral trauma necessitates retrograde urethrogram

Testicular ultrasound – helpful esp w/ test injury

o

Testical injury require exploration (surgically)

Superficial injuries – normal closure

Amputation – reimplantation possible (keep it cold) or partial penectomy

Avulsion:

o

Primary closure

o

Circumferential – remove skin to coronal sulcus and ST Skin Graft

Burns – don’t debride too much; replace catheter with suprapubic catheter

Fracture – rupture of tunica albuginea of c.carnosum

o

Exploration + removal of hematoma

Malignant Dz:

Premalignant

o

Leukoplakia- white plaque: local excision

o

Balantis xerotic obliterans white, atrophic, edematous penis local excision + steroids

o

Bowens: solitary erythematous plaque on shaft – 25% malignancy Carcinoma in Situ; Tx: YAG laser, local excision, topical 5-Fluoruracil

o

Erythroplasia of Queyrat – raised red well marginated areas – CIS : Tx with YAG laser, local excision, topical 5-Fluoruracil

o

Giant condyloma acuminatum: exophytic undistinguishable from Squamous CC.  local excisionpartial or complete penectomy

Squamous CC: rare in US

o

Common in hot, humid areas with poor hygiene and non circumcised

o

Presents w/ ulceration, necrosis, suppuration, hemorrhage

o

Exam, palpation, LFTs, CXR, CT abdomen + pelvis, bone scan

o

Small cancers on prepuce – Tx w/ circumcision

o

Partial penectomy w/ 2cm margin for small distal tumors.

5 year cure rate = 70-80%

o

Larger tumors – total penectomy + perineal urethrostomy

o

Dissect inguinal nodes if enlarged 4-6weeks after antibiotics

Sentinel nodes negative 90% 5 year survival

Sentinel positive unilateral 56% bilateral 9% 5 year survival

o

Radiation – not as effective, but works in small low stage tumors

Acquired Disorders:

Priapism: prolonged erection of only corpora cavernosa(spongiosum limp)

o

Low flow: venous flow obstructed --> thrombosis(sickle cell, leukemia, carcinoma, intracorporeal injection of impotency meds)

Can treat with phenylephrine

Aspiration of blood and irrigate w/ saline

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