Penile pathology

This guide covers common penile and testicular pathologies, their causes, symptoms, and treatments. This knowledge is essential for students preparing for the USMLE Step 1.

1. Penile Pathologies

Peyronie Disease

Definition: Abnormal curvature of the penis caused by fibrous plaque within the tunica albuginea.
Symptoms: Erectile dysfunction, pain, anxiety.
Treatment: Surgical repair or collagenase injections once curvature stabilizes.
Distinct Condition: Not to be confused with penile fracture, the rupture of corpora cavernosa due to forceful bending.

Condition	Cause	Symptoms	Treatment
Peyronie Disease	Fibrous plaque in tunica albuginea	Curved penis, erectile dysfunction	Surgery, collagenase injections

Ischemic Priapism

Definition: A painful erection lasting over 4 hours, often due to impaired venous drainage.
Associations: Sickle cell disease (sickled RBCs block venous channels), medications (e.g., sildenafil, trazodone).
Treatment: Immediate treatment is required with corporal aspiration, intracavernosal phenylephrine, or surgical decompression to prevent ischemia.

Condition	Cause	Symptoms	Treatment
Ischemic Priapism	Sickle cell disease, medications	Painful erection >4 hours	Aspiration, phenylephrine, decompression

Squamous Cell Carcinoma

Epidemiology: Rare in the U.S., more common in Asia, Africa, and South America.
Precursor Lesions:
- Bowen Disease: Leukoplakia (white plaque) on the penile shaft.
- Erythroplasia of Queyrat: Erythroplakia (red plaque) on glans.
- Bowenoid Papulosis: Reddish papules of unclear malignant potential.
Risk Factors: HPV, lack of circumcision.

Condition	Precursor Lesion	Appearance	Risk Factors
Squamous Cell Carcinoma	Bowen disease, erythroplasia	White/red plaques, reddish papules	HPV, uncircumcised males

2. Testicular Pathologies

Cryptorchidism

Definition: Failure of testicular descent.
Effects: Impaired spermatogenesis due to elevated temperature.
Hormonal Changes: Decreased inhibin B, increased FSH and LH; testosterone is decreased in bilateral cases.
Treatment: Usually resolves spontaneously; otherwise, orchiopexy (surgical fixation) before 2 years.

Condition	Symptoms	Hormonal Changes	Treatment
Cryptorchidism	Testicular malposition	↓ Inhibin B, ↑ FSH and LH	Orchiopexy if not resolved

Testicular Torsion

Definition: Twisting of the testicle around the spermatic cord.
Symptoms: Acute severe pain, high-riding testis, absent cremasteric reflex.
Treatment: Emergency surgical correction within 6 hours. If non-viable, orchiectomy is performed. Bilateral orchiopexy is recommended to prevent recurrence.

Condition	Cause	Symptoms	Treatment
Testicular Torsion	Spontaneous or post-trauma	Severe pain, high-riding testis	Surgery within 6 hours, orchiopexy

Varicocele

Definition: Dilated veins in the pampiniform plexus due to increased venous pressure.
Symptoms: Scrotal enlargement, usually on the left side, resembling a “bag of worms.”
Diagnosis: Physical exam (Valsalva maneuver), ultrasound.
Treatment: May be treated surgically if causing discomfort or infertility.

Condition	Cause	Symptoms	Diagnosis	Treatment
Varicocele	Increased venous pressure	Scrotal enlargement, “bag of worms”	Valsalva, ultrasound	Surgery

Points to Remember

Peyronie Disease: Look for abnormal penile curvature; treat with surgery or injections.
Ischemic Priapism: Requires immediate treatment to avoid tissue damage.
Squamous Cell Carcinoma: Watch for precursor lesions; HPV and circumcision status are risk factors.
Cryptorchidism: Increases risk of infertility and malignancy; early surgery is beneficial.
Testicular Torsion: Surgical emergency; treat within 6 hours to save the testis.
Varicocele: Common cause of scrotal enlargement, usually on the left side; may affect fertility.

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USMLE Step 1 Review Series

Curriculum

Penile pathology

1. Penile Pathologies

Peyronie Disease

Ischemic Priapism

Squamous Cell Carcinoma

2. Testicular Pathologies

Cryptorchidism

Testicular Torsion

Varicocele

Points to Remember

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