January Week 4: Penile Issues

Articles:
Wan J, et al.Common Penile Problems.Prim Care Clin Office Pract. 37(2010) 627–642.

Case 1:

You are examining a newborn in the nursery and note that his urethra is located at the corona on the ventral side, at the junction of the glans and the shaft of the penis. He voids during your exam and has several wet diapers recorded on his chart.

What do you tell the parents? 
What are risk factors for hypospadias? 
When would you refer for urology? 
How would you describe the location in your urology referral?

Case 2:

You are seeing a newborn in the nursery and note that the median raphe along his penis spirals around the shaft counterclockwise 360 degrees. There is no chordee and he has several wet diapers recorded on his chart.

What do you tell the parents? 
When would you refer to urology?

Case 3:

You are seeing a 5 yo boy in the ER. Mom reports that she noted the boy had swelling of his penis when she undressed him for his bath tonight. On exam, you note that the foreskin appears to be retracted with distal swelling of the penis. The boy does not appear to be in any distress.

What is your next step? 
When would you refer to urology? 
By what age can most boys retract their foreskins?

Case 4:

You are seeing 2 young boys in the ER who are accompanied by their mom. She reports that she had taken the two boys, age 4 and 6, into the women’s restroom at the mall because they both needed to urinate. The older boy zipped up his pants too quickly and his foreskin was caught in the zipper. Mom tried to unzip the zipper but brought him in because she was unable to do it.

What is your next step? 
When would you need to call a urologist?

Mom is overjoyed that you were able to successfully treat her son. She asks you to also examine her other son because in all the chaos, the toilet seat lid slammed down onto his penis. You note some bruising and mild swelling and tenderness.

What is your next step? When would you need to call a urologist?