MP15-03 MONKEYPOX AND THE PENIS: AN EMPIRICAL CARE PATHWAY

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP15-03 MONKEYPOX AND THE PENIS: AN EMPIRICAL CARE PATHWAY Piotr Sluzar, Alex Murray, Anna Daunt, Aatish Patel, Achyuta Nori, Geraldine O'Hara, and Tet Yap Piotr SluzarPiotr Sluzar More articles by this author , Alex MurrayAlex Murray More articles by this author , Anna DauntAnna Daunt More articles by this author , Aatish PatelAatish Patel More articles by this author , Achyuta NoriAchyuta Nori More articles by this author , Geraldine O'HaraGeraldine O'Hara More articles by this author , and Tet YapTet Yap More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Monkeypox is a viral illness affecting predominantly gay, bisexual and other men having sex with men. The rapid progression of the recent outbreak meant genital manifestations preceded any guidelines for cases with urological symptoms. This study aims to develop an empirical care pathway for patients presenting with penile and scrotal symptoms secondary to monkeypox. METHODS: From May to September 2022, 198 patients with monkeypox who presented to a tertiary referral hospital were assessed for genital involvement by the infectious disease team, with the involvement of a urologist. Of these, 19 patients (10%) were admitted with genital lesions and were treated in an isolation ward with full personal protection equipment (PPE) in use. Symptoms requiring urological input were present in 8 individuals (4%). The mean time from the onset of symptoms to resolution was 25.3 (range 9-63) days. Based on the management of these patients, an empirical care pathway for genital monkeypox was developed. RESULTS: Four stages of genital monkeypox were observed (Figure 1). Limited penile oedema and discrete lesions should be managed conservatively with analgesia, cold compresses and elevation for swelling control. Patients with moderate oedema, paraphimosis and large coalescing ulcers should be considered for a topical 1% hydrocortisone cream to reduce the inflammation. In severe oedema with necrotic ulcers glyceryl trinitrate (GTN) patches are crucial to improve the vascularization of the necrotic ulcers on the penis. Cases of widespread necrosis and oedema may require imaging to assess the need for surgical debridement. GTN patches require daily changes for tissue salvage. Catheterization should be guided by the extent of oedema, the presence of paraphimosis and lesions close to the external urethral orifice. CONCLUSIONS: Monkeypox cases presenting through lesions on the penis and scrotum often require urological management to reduce penile oedema and prevent catheterisation. All admitted patients require isolation with full PPE. The initial stages of the infection should be managed conservatively with cold compresses, elevation and analgesia. Patients with advanced genital symptoms can benefit from the early use of topical steroid creams and GTN patches applied over the necrotic areas to reduce swelling and aid perfusion. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e192 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Piotr Sluzar More articles by this author Alex Murray More articles by this author Anna Daunt More articles by this author Aatish Patel More articles by this author Achyuta Nori More articles by this author Geraldine O'Hara More articles by this author Tet Yap More articles by this author Expand All Advertisement PDF downloadLoading ...