Common penile diseases: priapism, fractures, and induration

Priapism is a condition characterized by painful, persistent erections of the penis without sexual desire or stimulation. This condition is rare in China. If not treated promptly in its early stages, it can lead to penile necrosis, fibrosis, impotence, and psychological trauma. Therefore, this condition should be treated as an emergency and addressed as early and correctly as possible.

In most cases, the cause is difficult to find clinically, hence the term primary penile erection. Its precipitating factors are classified into four categories:

1. Psychological and neurological factors such as central nervous system diseases, central nervous system dysfunction (tumors or syphilis, etc.), and psychological trauma caused by interruption of sexual intercourse due to severe fright.

2. Blood-related factors such as chronic myeloid leukemia, sickle cell anemia, diabetes, or gout can cause increased blood viscosity and thrombophlebitis.

3. Local organic lesions of the penis: Penile trauma, metastatic tumors within the corpora cavernosa directly stimulating the dorsal nerve of the penis. Infiltration and persistent compression from pelvic tumors (such as bladder or prostate cancer).

4. Drug-induced causes, such as antihypertensive tablets for treating hypertension, large doses of 6-aminocaproic acid for nosebleeds, or large doses of hemostatic agents for gastrointestinal bleeding, have all been reported to cause priapism.

This condition commonly occurs in married middle-aged patients, most of whom are asexual; a minority experience painful, rigid erections during intercourse, lasting for varying durations. Local examination reveals the penis is erect at a 50° angle to the abdominal wall; unlike normal penile erection, only the corpora cavernosa are erect, while the glans and corpus spongiosum remain erect. The glans penis appears bluish, and edema quickly develops on the foreskin. If the erection lasts more than 48 hours, thrombosis can occur within the corpora cavernosa, causing the entire penis to harden. Continued erections transform from the initial reflex erection into a thrombosclerotic erection. After 10 days, the corpora cavernosa harden, resulting in permanent organic erectile dysfunction.

The goal of treatment is to improve blood circulation and relax the erect penis, restoring normal sexual function. It is generally believed that any erection lasting 4-6 hours or longer should be addressed; erections exceeding 24 hours may lead to adverse consequences.

1. Initially, non-surgical treatments should be tried, including the use of sedatives, estrogen, local cold compresses, acupuncture, traditional Chinese medicine, and epidural anesthesia. In the early stages, a large-bore needle can be used to puncture the corpora cavernosa of the penis to release 20-70 ml of blood, or after removing the stagnant blood, the penis can be repeatedly flushed with a 1:1000 heparinized saline solution.

2. Surgical treatment should be performed as early as possible using shunt surgery that increases penile venous return. The following methods can be selected: ① shunt between the glans cavernosa and the corpus cavernosum; ② shunt between the corpus cavernosum and the corpus spongiosum; ③ unilateral or bilateral anastomosis of the corpus cavernosum with the great saphenous vein; ④ shunt between the corpus cavernosum and the superficial or deep dorsal veins of the penis.

Treatment of secondary penile erection must first remove the underlying cause of the condition, and the aforementioned treatments can be used in conjunction with this approach.

Among the various emergencies in urology, perhaps the most embarrassing situation for patients is penile fracture. When a man's penis is not erect, it is a soft organ and cannot be broken; however, if the penis is subjected to acute external force while erect, then penile fracture is possible.

The key to penile erection lies in the structure of the corpora cavernosa within the penis. When the penis is erect, a large amount of blood flows into the corpora cavernosa, much like a small balloon being inflated. If, under these conditions, external force causes the corpora cavernosa to rupture, penile fracture can occur. The most common time for penile fracture is during sexual intercourse.

When the penis fractures, in addition to sudden, severe pain, the person may hear a crisp popping sound, like a balloon bursting. The penis will then develop bruising, which can quickly progress into severe swelling and bruising, making the entire penis swollen and enlarged. This is actually internal bleeding caused by the leakage of blood from the corpora cavernosa after the corpora cavernosa ruptures. The most appropriate treatment at this time is to seek immediate medical attention for surgical repair of the ruptured corpora cavernosa to immediately eliminate the swelling and prevent future sexual dysfunction. Furthermore, some patients with penile fractures may also experience urethral injury, resulting in bleeding from the urethral opening, which also needs to be addressed during the treatment of the penile fracture.

While penile fractures are uncommon, the panic and uncertainty experienced by those involved can delay medical attention, potentially impacting future erectile function. These incidents often occur when attempting unusual sexual positions, causing penile twisting or sudden impact that leads to breakage. Some statistics suggest that the woman-on-top position is more prone to penile fractures, and with increasingly open sexual attitudes, this acute condition may become more prevalent.

Peyronie's disease, also known as penile fibrosis or cavernositis, is characterized by inflammatory fibrosis and induration of the corpora cavernosa and tunica albuginea. The etiology remains unclear, but it is generally believed to be related to injury, infection, immunity, and vitamin E deficiency. Recent reports suggest a possible link to certain genetic factors. The lesions occur within the tunica albuginea or corpora cavernosa of the penis. Initially, lymphocytes and plasma cells infiltrate around small blood vessels in the connective tissue, rapidly progressing to fibrosis and plaque formation. Later, the disease progression slows, and although localized calcification or ossification may occasionally occur, there is no tendency for malignant transformation.

Currently, there are no effective treatments available, and a comprehensive approach is generally recommended. Non-surgical treatment is suitable for early-stage, milder lesions, and in some cases, the lesions may spontaneously remit or stop progressing. It has been reported that oral administration of a large dose of vitamin E (100mg) three times daily for three months can alleviate or eliminate symptoms in approximately 20% of early-stage patients. Physical therapy, often using audio-visual ablation devices, has some effect on earlier lesions, causing capillary dilation and increased blood flow within the fibrous mass, which is beneficial for the recovery of nerve and vascular function. In some cases, the induration shrinks, and painful erections improve or disappear. Local superficial X-ray irradiation has analgesic and induration-releasing effects, showing some efficacy in a few cases, but it cannot cure the condition. Other methods include the application of traditional Chinese medicine Xuefu Zhuyu Decoction, massage, medium-wave or microwave penetration, and magnetic therapy, which can also achieve some symptomatic treatment effects, but the induration is difficult to eliminate.

There is currently no consensus on the surgical removal of lesions. For patients with obvious symptoms and localized, single lesions with induration, surgical resection combined with skin grafting to the defect area may be considered. Strict hemostasis should be maintained during the operation to prevent postoperative worsening of the condition. For patients with erectile dysfunction, negative pressure suction sexual function rehabilitation therapy machines can be used; some also suggest that penile prosthesis implantation should be performed simultaneously with surgical resection of the induration.

[Ingredients]7 eggs, 50g euphorbia, 30g orange seeds.

[Preparation] Boil the egg with euphorbia and orange seeds. Once the egg is cooked, remove it and eat only the egg. One egg per day.

[Efficacy] It eliminates phlegm, promotes blood circulation, and dissipates nodules, and is mainly used to treat Peyronie's disease.

[Ingredients]500g sea cabbage, 100g white silkworm, 20g white plum flesh, buckwheat.

[Administration] Stir-fry sea lettuce and buckwheat until the buckwheat turns golden brown, then sift out the buckwheat and grind it into powder. Stir-fry silkworm pupae until the silk threads break, then grind them into powder. Mix the two powders together and make pills with water boiled with white plum flesh. Take 30-50 pills each time with rice water before bedtime, for several days.

[Efficacy] Softens and disperses nodules. Primarily used to treat Peyronie's disease.

Genital herpes is a sexually transmitted disease primarily caused by the herpes simplex virus type II. In Western countries, its incidence rate is second only to gonorrhea and non-gonococcal urethritis, and it is also one of the common sexually transmitted diseases in my country. This disease has a high incidence rate and can infect newborns through the placenta and birth canal, leading to miscarriage and neonatal death. It is also associated with the development of cervical cancer, posing a significant threat. Given the lack of a specific treatment, it has received considerable attention. It commonly occurs on the glans penis, foreskin, or dorsal surface of the penis.

Based on the typical characteristics of the infectious lesions, diagnosis is not difficult, but it should be differentiated from drug allergies, candidiasis, chancroid, and carcinoma. A definitive diagnosis can be confirmed if the virus can be isolated from the ulcer surface. Because this disease often coexists with sexually transmitted infections, serum Kanger's reaction and other tests should be performed. There is no specific treatment for genital herpes. Keep the affected area clean and apply anti-inflammatory drugs and antibiotics; for those with existing ulcers, 2%–3% silver nitrate can be used for treatment.

Diagnosis is not difficult based on the typical characteristics of clustered blisters on the vulva, local burning sensation, history of recurrence, and short course of disease. Laboratory diagnosis can be performed for some atypical lesions.

Genital herpes is caused by infection with the herpes simplex virus (HSV). There are two types of HSV: HSV-1 and HSV-2. HSV-1 is transmitted through close contact with the respiratory tract, skin, and mucous membranes, primarily causing infections of the lips, pharynx, eyes, and skin; a small percentage (approximately 10%) can also cause genital infections. HSV-2 is the main pathogen of genital herpes (90%), present in the exudate of skin and mucous membrane lesions, semen, prostatic secretions, cervical secretions, and vaginal secretions. It is mainly transmitted through sexual intercourse, causing primary genital herpes. After the primary genital herpes subsides, the remaining virus remains latent in the sacral ganglion along the nerve axis via peripheral nerves. When the body's resistance decreases or certain triggering factors such as fever, cold, infection, menstruation, gastrointestinal dysfunction, or trauma occur, the latent virus can be activated, leading to a recurrence.

Humans are the only host for the herpes virus. The virus cannot survive outside the human body. Ultraviolet light, ether, and common disinfectants can all inactivate it.

1. Acyclovir is a highly broad-spectrum antiviral drug that inhibits viral DNA polymerase, preventing DNA synthesis. The oral dose is 200 mg five times daily for 10 days. Alternatively, it can be administered intravenously at a dose of 5 mg/kg every 8 hours for 5 days.

2. Cytarabine 0.2–2 mg/kg, intravenous drip for 5 days.

3. Phthalobutamide can inhibit HSV replication and is effective in treating recurrent herpes.

4. Polyinosinic acid (polyinosinic-cytokine) 2mg intramuscular injection, once every 2-3 days.

5. Intravenous or subcutaneous injection of α2 interferon, intramuscular injection of transfer factor, and oral administration of levamisole also have certain therapeutic effects.

Compound zinc-copper wet compresses, 5% acyclovir ointment, phthalimide ointment, 0.1% herpes simplex solution, 0.1% gentian violet solution, etc. can be used externally.

Fixed drug eruption is a type of drug reaction that occurs on the skin and mucous membranes, commonly affecting the genital area in both men and women. The rash presents as well-defined, round or oval purplish-red patches, ranging in size from a little finger to a thumb. It is usually solitary, but can occur in multiples; in severe cases, vesicles may develop from the erythema. Post-treatment pigmentation occurs, and the pigmentation deepens with each recurrence and can be persistent. Symptoms are generally mild, but in severe cases with vesicles and erosions, there is significant burning pain. Because after the first occurrence of the rash, if the same medication is taken again, itching will occur at the same site, followed by the reappearance of the same rash, which tends to expand and increase in number, exhibiting a fixed characteristic, it is called fixed drug eruption. It is a common drug-induced allergic skin disease. Some commonly used clinical medications, such as sulfonamides (e.g., compound sulfamethoxazole), antipyretic analgesics (e.g., aspirin, somitone, indomethacin), and sedative-hypnotic drugs (e.g., diazepam), can all cause this condition. Moreover, the onset of the disease is unrelated to the dosage of the drug; some patients in a sensitive state may develop drug rashes even with very small doses.

Why does it commonly occur in the genital area? This is likely due to the relatively loose subcutaneous tissue and rich blood supply in this area. The rash is most often found at the junction of skin and mucous membranes, such as the lips, glans penis, and anus; it can also occur on the backs of the hands and feet, and the trunk. In men, it is most commonly found on the glans penis, coronal sulcus, foreskin, and scrotum, while in women it is most commonly found on the labia majora and minora.

Fixed drug eruptions are easily confused with chancroid, but chancroid patients typically have a history of unprotected sex before the onset of the disease, and present with one or more ulcers on the genitals or other areas. These ulcers have a soft base, are painful and tender to the touch, and may present with unilateral lymphadenopathy, which are clearly different from fixed drug eruptions. Regarding the treatment of fixed drug eruptions, the first step is to discontinue all suspected medications, followed by the administration of anti-allergy medications, which usually yields good results.

Pearly penile papules are relatively common in adult men aged 20-40. Previously, they were not taken seriously, but in recent years, with the increase in sexually transmitted diseases, the number of patients seeking treatment has also increased. Generally, the person doesn't experience much discomfort and often discovers them accidentally while showering. Domestic surveys indicate that over 20% of adult men have these papules, varying only in severity. The typical clinical presentation is as follows: tiny, pinhead-sized papules, resembling pearls, appear on the dorsal and lateral sides of the coronal sulcus. They are white, yellow, or pink, arranged in one or several rows along the coronal sulcus, sometimes encircling it. They are relatively hard, and characterized by not itching, pain, or ulceration, and generally do not require treatment. However, if some men have phimosis (tight foreskin), poor hygiene, and frequent accumulation of smegma leading to infection, circumcision may be considered. In clinical practice, penile pearly papules need to be differentiated from condyloma acuminata. Most patients with condyloma acuminata have a history of promiscuity. The wart-like growths continue to proliferate, growing into a cauliflower-like shape with a rough and uneven surface. Moreover, the distribution is uneven, asymmetrical, and irregular. When differentiation is difficult, patients can consult a urologist and undergo tests such as the acetic acid whitening test, which can usually lead to a diagnosis.