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Penile lesions


Penile lesions are common. They can interfere with quality of life and affect sexual intercourse. The majority of surgical conditions of the penis relate to problems with the foreskin and glans. Carcinoma of the penis and Peyronie’s disease are rare.

Causes

Foreskin and glans

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    Penile lumps (pearly penile papules, molluscum contagiosam, fordyce spots)

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    Phimosis

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    Paraphimosis

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    Balanoposthitis

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    Balanitis xerotica obliterans

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    Herpes genitalis

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    Condylomata (warts)

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    Trauma (bite)

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    Carcinoma ( Fig. 48 )

    Figure 48, Carcinoma of the penis, revealed with the foreskin retracted .

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    Erythroplasia of Queyrat (carcinoma in situ)

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    Chancre (syphilis)

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    Behcet’s disease

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    Bowen’s disease

Shaft of the penis

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    Peyronie’s disease

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    Priapism

Urethra

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    Epispadias

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    Hypospadias

History

Foreskin and glans

Penile lumps

Pearly penile papules are small lumps often found in a row which are seperate from warts. Molluscum are pearly spots with a central umbilicated area common in children. Fordyce spots are simply visible sebaceous glands that occur during adolescence.

Phimosis

In most cases, phimosis is congenital. The foreskin has been tight since birth and the patient complains that it will not retract over the glans. In children, this may cause pain with ballooning of the foreskin during micturition, with resulting balanoposthitis. In adults, the complaint is that it interferes with sexual intercourse.

Paraphimosis

The foreskin is pulled back over the glans while washing and then is not returned. It may also occur during sexual intercourse. In hospital practice, it may occur while the patient is being catheterised and the foreskin is not returned to its correct place following this procedure. The foreskin forms a tight constriction around the glans, interfering with venous return and causing swelling of the glans and foreskin. The patient presents with considerable pain and a swollen glans penis.

Balanoposthitis

This is inflammation of the glans and foreskin. The patient complains of an attack of inflammation of the foreskin and glans. It may be associated with poor hygiene, but in children it is often associated with phimosis and collection of urine under the foreskin. In diabetics, it is often due to candida.

Balanitis xerotica obliterans

Also known as lichen sclerosus et atrophicus. The patient will complain of thickening and tightening of the foreskin, and the inability to retract it. This is often seen in uncircumsised men.

Herpes genitalis

The patient will complain of painful vesicles on the foreskin or glans penis. Primary infection is often severe with accompanying fever. There will usually be a history of sexual contact.

Condylomata (warts)

The patient may present with warts on the glans and contiguous surface of the prepuce. They are usually of venereal origin.

Trauma

There may be a history of trauma. Love bites may be responsible.

Carcinoma

This usually presents in old age. It is virtually unknown in those who are circumcised. Most patients present with a lump or an ulcer which may be painful. In uncircumcised patients who cannot retract the foreskin, there may be a bloodstained purulent discharge from under the foreskin.

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