๐ Stepwise Approach to Penile & Urethral Anomalies
๐ Key Principles โ Nelson Ch 581
โข Hypospadias: Ventral meatus, dorsal hood, chordee. 65% distal. DO NOT circumcise (foreskin used for repair). Repair at 6-12 months. Success 95% (distal) to 60% (proximal).
โข Phimosis: Physiologic at birth. By 3 years, 80% retractable. Persistent phimosis โ topical steroids. Paraphimosis: emergency; reduce edema, manual reduction.
โข Circumcision: UTI prevention (10-15x reduction). Contraindications: hypospadias, chordee, hidden penis, micropenis.
โข Priapism: Most common in sickle cell disease. Low-flow (ischemic): corporal aspiration + phenylephrine. High-flow (traumatic): observation or embolization.
โข Urethral prolapse (female): Bloody spotting, 1-9 years. Estrogen cream or surgical excision.