Growths on the Penis
Growths on the penis are sometimes caused by infections. One example is syphilis (see Sexually Transmitted Diseases: Syphilis), which may cause flat pink or gray growths (condylomata lata). Also, certain viral infections can produce one or more small, firm, raised skin growths (genital warts, or condylomata acuminata) or small, firm, dimpled growths (molluscum contagiosum). Skin cancer can occur anywhere on the penis, but it most commonly occurs at the glans penis (the cone-shaped end of the penis), especially its base. Cancers affecting the skin of the penis, uncommon in the United States, are even rarer in men who have been circumcised. The cause of cancer of the penis may be long-standing irritation, usually under the foreskin. Squamous cell carcinoma (see Skin Cancers: Squamous Cell Carcinoma) occurs most commonly. Early forms of cancer that are less common include Bowen's disease (see Skin Cancers: Bowen's disease), Paget's disease (see Skin Cancers: Paget's Disease of the Nipple), and erythroplasia of Queyrat. Cancer usually first appears as a painless, reddened area with sores that do not heal for weeks. Erythroplasia of Queyrat usually occurs in uncircumcised men. It produces a discrete, reddish, velvety area on the penis, usually on or at the base of the glans penis. To diagnose cancer of the penis, doctors remove a tissue sample for examination under a microscope (biopsy). To treat early or small cancers, doctors prescribe a cream containing fluorouracil or remove the cancer and some normal surrounding tissue with a laser or during surgery. For other cancers, doctors surgically remove the cancer, sparing as much of the penis as possible. When a lot of tissue is removed, the penis needs to be rebuilt surgically. In most men, cancers are small and have not spread. These men survive for many years after treatment. Most men with cancer that has spread die within 5 years.
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Inflammation of the Penis
The foreskin of the penis and the glans penis (the cone-shaped end of the penis) can be inflamed. Inflammation of the penis can be caused by infections, such as yeast infections, sexually transmitted diseases (STDs), and scabies. Noninfectious causes include skin disorders, including balanitis xerotica obliterans. The inflammation causes pain, itching, redness, and swelling and can ultimately lead to a narrowing (stricture) of the urethra. Balanoposthitis often begins with balanitis. It develops more often if the foreskin is tight or if a man has diabetes mellitus. Men who develop balanoposthitis have an increased chance of later developing balanitis xerotica obliterans, phimosis, paraphimosis, and penile cancer. Diagnosis is usually by physical examination. Blood sugar may be measured to test for diabetes, and tests for yeast infections and STDs may be done. The cause of inflammation is treated. Balanitis xerotica obliterans (also called lichen sclerosus et atrophicus) occurs when chronic inflammation causes the skin near the tip of the penis to harden and turn white. The opening of the urethra is often surrounded by this hard white tissue, which eventually blocks the flow of urine and semen. Antibacterial or anti-inflammatory creams may relieve the inflammation, but if the urethra must be reopened, it is done surgically.
Inguinal Hernia
An inguinal hernia is a protrusion of a piece of intestine through an opening in the abdominal wall in the groin. An inguinal hernia extends into the groin, and can extend into the scrotum. Other types of hernias (such as umbilical hernias and femoral hernias) occur at other locations (see Gastrointestinal Emergencies: Abdominal Wall Hernias). With an inguinal hernia, the opening in the abdominal wall can be present from birth or develop later in life.
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What Is an Inguinal Hernia? |
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In an inguinal hernia, a loop of intestine pushes through an opening in the abdominal wall into the inguinal canal. The inguinal canal contains the spermatic cord, which consists of the vas deferens, blood vessels, nerves, and other structures. Before birth, the testes, which are formed in the abdomen, pass through the inguinal canal as they descend into the scrotum. |
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Inguinal hernias usually produce a painless bulge in the groin or scrotum. The bulge may enlarge when men stand and shrink when they lie down because the intestine slides back and forth with gravity. Sometimes a portion of the intestine is trapped in the scrotum (incarceration). If the intestine becomes trapped, the intestine's blood supply can be cut off (strangulation). Strangulated intestine may die (become gangrenous) within hours. Surgical repair usually aims to tighten the opening so the hernia cannot slide back into the groin. Surgery usually relieves the symptoms of a hernia, depending on its size and the amount of discomfort it causes. For strangulated hernias, emergency surgery is needed to pull the intestine out of the inguinal canal and tighten the opening. |
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Injuries to the Penis and Scrotum
Several types of injuries can affect the penis. Cuts to the Penis: Catching the penis in a pants zipper is common, but the resulting minor cut usually heals quickly. Cuts usually heal quickly if they are simply kept clean, but people may need to take antibiotics by mouth if the cuts become infected. The penis can be partially or fully severed. Reattachment of a severed penis is sometimes possible, but full sensation and function are rarely recovered. Urethral Injury: Injuries to the tube that carries urine through the penis (the urethra) are serious because they may result in scarring that obstructs the flow of urine. These injuries may result from blunt injury, such as a fall straddling a fence rail or bicycle handlebar, from deep cuts, or as a complication of surgical procedures. They typically require treatment by a urologist. Fracture of the Penis: Excessive bending can fracture an erect penis. Such bending may occur during vigorous sexual intercourse if the penis is stubbed against the partner's pelvic bone. The “fracture” is actually a tear in one of the two tube-like structures in the penis (corpus cavernosum) that hold the extra blood flow that maintains erection. The man has immediate pain and swelling, and the penis appears deformed. The injury often damages the structures that control erection and after the injury heals, the man may have difficulty with intercourse, urination, or both. Emergency surgery is usually necessary to repair such fractures to prevent abnormal curvature of the penis or permanent erectile dysfunction. Injury of the Scrotum and Testes: The location of the scrotum makes it susceptible to injury. Blunt forces (for example, a kick or crushing blow) cause most injuries. However, occasionally gunshot or stab wounds penetrate the scrotum or testes. Rarely, the scrotum is torn off the testes. Testicular injury causes sudden, severe pain, usually with nausea and vomiting. Ultrasound examination may show whether the testes have ruptured. Ice packs, a jockstrap, and drugs for pain and nausea usually effectively treat bleeding in or around the testes. Ruptured testes require surgical repair. When the scrotum is torn off, the testes can die or lose their capacity for hormone or sperm production. Surgery to cover the testes by reconstructing the scrotum or simply by burying them under the skin of the thighs protects the testes.
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Peyronie's Disease
Peyronie's disease is a fibrous thickening that contracts and deforms the penis, distorting the shape of an erection. Many men have a small degree of curvature of their erect penis. Peyronie's disease produces a more severe curvature. Inflammation in the penis results in the formation of fibrous scar tissue that causes curvature in the erect penis, making penetration difficult or impossible. However, what causes the inflammation is not known with certainty. The condition can make an erection painful. The scar tissue can extend into the erectile tissue (corpora cavernosa), preventing erection from occurring. Minor curvature that does not impair sexual function does not require treatment. Peyronie's disease may resolve over several months without treatment. No treatment has proven clearly successful. Vitamin E, which can aid wound healing and decrease scarring, may be taken by mouth. Para-aminobenzoate can also be taken by mouth but sometimes causes stomach pain or digestive problems and requires taking many pills each day. Corticosteroids or verapamil can be injected into the scar tissue to decrease inflammation and reduce scarring. Ultrasound treatments can stimulate blood flow, which may prevent further scarring. Radiation therapy may decrease pain, but radiation therapy often worsens tissue damage. Surgery is not recommended unless the disease has progressed and the curvature has become too severe for successful intercourse. Surgery to remove the scar tissue shortens the penis and may worsen the disease or result in erectile dysfunction.
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Phimosis and Paraphimosis
Phimosis: In phimosis, the foreskin is tight and cannot be retracted over the glans penis (the cone-shaped end of the penis). This condition is normal in newborns and young boys and usually resolves without treatment by about age 5. In older men, phimosis may result from prolonged irritation or recurring balanoposthitis. The tightened foreskin can interfere with urination and sexual activity and may increase the risk of urinary tract infections. The usual treatment is circumcision. However, in children, sometimes the application of a corticosteroid cream 2 or 3 times daily and periodic gentle stretching of the foreskin are effective and spare the child a circumcision. The cream may be used for up to 3 months. Paraphimosis: In paraphimosis, the retracted foreskin cannot be pulled forward to cover the glans penis. The condition most commonly develops when the foreskin is left retracted after a medical procedure (such as catheterization) or after cleaning the penis of a child. The glans penis swells, increasing pressure on the retracted foreskin, which then becomes trapped. The increasing pressure eventually prevents blood from reaching the penis, which could result in the destruction of penile tissue if the foreskin is not pulled back forward. Immediate treatment involves squeezing the glans penis to shrink it so that the foreskin can be pulled forward. If this technique does not work, the penis is anesthetized and the foreskin is slit to relieve the constriction. Later, circumcision is done.
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Priapism
Priapism is a painful, persistent erection unaccompanied by sexual desire or excitement. Priapism probably results from abnormalities of the blood vessels and nerves that cause blood to become trapped in the erectile tissue (corpora cavernosa) of the penis. In most cases, priapism is caused by drugs taken to cause erection. Drugs may be those taken by mouth (for example, sildenafil , tadalafil , or vardenafil ) or injected into the penis (for example, alprostadil ). Other causes of priapism include blood clots, leukemia, sickle cell disease (particularly in children), a tumor in the pelvis, an injury to the penis or surrounding areas, dysfunction of the spinal cord, and use of other drugs, such as certain antidepressants, drugs used to treat other psychologic disorders, cocaine, and marijuana. Sometimes, however, no cause can be found. Several symptoms help differentiate priapism from normal erections. Priapism lasts longer, usually several hours. Sexual excitement does not accompany priapism, and the erection is usually painful. Also, in priapism, the glans penis (the cone-shaped end of the penis) may be soft. Applying ice, climbing stairs, or both may help. These measures can be taken immediately and done easily. Any drug that appears to cause the priapism is stopped immediately. Injection into the penis of a drug that decreases erection (for example, phenylephrine ) can relieve priapism, particularly priapism caused by injection of a drug into the penis. Spinal anesthesia may relieve priapism caused by a spinal cord injury. When a blood clot is the probable cause, surgery to remove the clot or restore normal circulation in the penis is necessary. Usually, when other treatments are ineffective or priapism has lasted more than 4 hours, priapism can be treated by draining excess blood from the penis with a needle and syringe and using fluid to wash out any blood clots or other blockages from the blood vessels. One or more of many possible drugs may also be used, depending on the cause. Prolonged priapism usually impairs erectile function permanently. Swelling in the Scrotum
Hydrocele: A hydrocele is a collection of fluid in the membrane that covers the testis or testes. A hydrocele may be present at birth or develop later in life. It is most common after age 40. Usually the cause is unknown. However, the condition occasionally results from a testicular disorder (for example, injury, epididymitis, or cancer). Usually, a hydrocele does not cause symptoms. It is found as a painless swelling surrounding the testis. Doctors may shine a bright light on the swelling (transillumination) to confirm the diagnosis. Ultrasound examination of the testis is done in unusual instances—for example, in a young man with no apparent cause for the hydrocele. The ultrasound scan may reveal an infection or tumor. Most hydroceles need no treatment. However, unusually large hydroceles are sometimes removed surgically. Edema: Edema is fluid retention involving the entire scrotum. Edema may result from salt and water retention or blockage of the flow of lymphatic fluid (see Lymphatic Disorders: Lymphedema). In both cases, people have no pain. Salt and water retention most commonly occurs because of heart failure, kidney failure, or chronic liver disease. Lymphedema results from blockage of lymph fluid most often because of compression of the abdominal or pelvic lymph vessels (for example, by a tumor or infection by certain kinds of parasites). Doctors usually diagnose the cause of edema based on people's symptoms and findings from a physical examination. Sometimes blood tests are done to evaluate liver and kidney function. Doctors treat edema by treating the cause. Orchitis: Infection of the testes (orchitis) is usually caused by a virus, most often mumps. Mumps usually affects children. If an adult contracts mumps, the testes can become painful and swollen and may sometimes later shrink and stop working (atrophy). Usually the diagnosis can be determined based on symptoms. Analgesics and cold or warm packs can help relieve pain. Infection usually resolves on its own without causing permanent problems. Sometimes mumps can permanently damage the ability of the testes to produce sperm but does not usually cause complete infertility unless it affects both testes. Spermatocele: A spermatocele is a collection of sperm in a sac that develops next to the epididymis. Most are painless. While most spermatoceles need no treatment, one that becomes large or bothersome can be removed surgically. Varicocele: Varicocele is the development of varicose veins in the blood vessels that drain the testis. Veins contain valves that prevent blood from flowing backward. Faulty valves can result in a varicocele. Varicoceles usually develop on the left side of the scrotum and may produce no symptoms. Alternatively, varicoceles may cause a sense of fullness and aching and throbbing pain that become bothersome when a man stands. The varicocele feels like a bag of worms if the scrotum is touched when the man is standing. However, the swelling usually disappears and symptoms resolve when he reclines because blood flow to the enlarged veins decreases. Rarely, a varicocele impairs fertility. If symptoms are severe, doctors may surgically tie off the affected veins.
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Testicular Cancer
Most testicular cancers develop in men younger than age 40. It is one of the most common cancers in young men. Among the types of cancer that develop in the testes are seminoma, teratoma, embryonal carcinoma, and choriocarcinoma. The cause of testicular cancer is not known, but men whose testes did not descend into the scrotum (cryptorchidism—see Problems in Infants and Very Young Children: Undescended and Retractile Testes) by age 3 have a greater chance of developing testicular cancer than do men whose testes descended by that age. Cryptorchidism is best corrected surgically in childhood. Correcting cryptorchidism decreases the risk of testicular cancer. However, even if cryptorchidism is corrected, the risk of cancer is still higher than for men who never had cryptorchidism. Sometimes in adults, doctors recommend removal of a single undescended testis to reduce the risk of cancer. Symptoms Testicular cancer may cause an enlarged testis or a lump. A testis normally feels like a smooth oval, with the epididymis attached behind and on top. Testicular cancer produces a firm, growing lump in or attached to the testis. With cancer, the testis loses its normal shape, becoming large, irregular, or bumpy. Although testicular cancer is usually painless, the testis or lump may hurt when lightly touched and may even hurt without being touched. A firm lump on the testis requires prompt medical attention. Occasionally, blood vessels rupture within the tumor, yielding a suddenly enlarged, severely painful swelling. Diagnosis Physical examination and ultrasound scanning may indicate whether a lump is part of the testis and whether it is solid (and thus more likely to be cancer) or filled with fluid (cystic). Determining the blood levels of two proteins, alpha-fetoprotein and human chorionic gonadotropin, may help in making the diagnosis. The levels of these proteins often increase in men with testicular cancer. If cancer is suspected, surgery to remove the testis is done promptly. Most doctors recommend testicular self-examination. Treatment The initial treatment for testicular cancer is surgical removal of the entire affected testis (radical orchiectomy). An artificial testis (prosthesis) can be placed if the man desires. The other testis is not removed, so men retain adequate levels of male hormones and remain fertile. Infertility sometimes occurs in men with testicular cancer, but fertility may return after treatment. With certain types of cancers, lymph nodes in the abdomen are also removed (retroperitoneal lymph node dissection) because the cancer often spreads there first. Radiation therapy may also help, especially for a seminoma. A combination of surgery and chemotherapy often cures testicular cancer that has spread. Blood levels of alpha-fetoprotein and human chorionic gonadotropin that were elevated at diagnosis decline after successful treatment. If levels rise after treatment, the cancer may have recurred. The prognosis for men with testicular cancer depends on the type and extent of the cancer but is usually excellent if the cancer has not spread. Even if the cancer has spread, cure is sometimes possible.
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Testicular Torsion
Testicular torsion is the twisting of a testis on its spermatic cord so that the testis's blood supply is blocked. Testicular torsion usually occurs in men between puberty and about age 25, but it can occur at any age. Abnormal development of the spermatic cord or the membrane covering the testis makes testicular torsion possible. With torsion, the testis usually dies within 6 to 12 hours after the blood supply is cut off unless it is treated. Severe pain and swelling develop suddenly in the testis. The pain may seem to come from the abdomen, and nausea and vomiting may develop. Doctors may diagnose the condition based on a description of the symptoms and the physical examination findings. Alternatively, doctors may use a scan, usually an ultrasound scan, for diagnosis. Testicular torsion is an emergency because the testis will die unless it is untwisted rapidly. Doctors may try to untwist the testis without surgery by rotating it within the scrotum. Occasionally, this procedure is successful and surgery is done later. However, usually the procedure is unsuccessful, and surgery to untwist the spermatic cord is required immediately. During surgery, whether done immediately or later, urologists usually secure both testes to prevent future episodes of torsion. http://www.merck.com | |
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Urethral Stricture
A urethral stricture is scarring that narrows the urethra. A urethral stricture most commonly results from a previous injury. Often no cause can be found. Prior infection is an infrequent cause. A less forceful urinary stream or a double stream usually occurs with mild strictures. Severe strictures may completely block the stream of urine. Pressure builds up behind the stricture and may cause passages from the urethra into the surrounding tissues (diverticula). By decreasing the frequency or completeness of urination, strictures often lead to urinary tract infections. Urologists (doctors who specialize in the diagnosis and treatment of genitourinary disorders) diagnose strictures by obtaining an x-ray after putting radiopaque dye into the urethra (retrograde urethrogram) or by looking directly into the urethra through a flexible viewing tube (cystoscope) after administering a lubricant containing a local anesthetic. To treat a stricture, urologists widen (dilate) the urethra by anesthetizing it and then inserting an instrument that forces the narrowing farther open. Or urologists can cut the stricture open (urethrotomy). Sometimes, scar tissue forms after strictures are treated, causing urethral strictures to recur. If strictures recur, the scar tissue may have to be removed surgically and the urethra may need to be rebuilt. Last full review/revision October 2008 by Paul D. Lui, MD | |
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