Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Disorders of Penis


Related Terms

  • Balanitis Xerotica Obliterans
  • Balanoposthitis
  • Cancer of the Penis
  • Condyloma Acuminatum
  • Epispadias
  • Erythroplasia
  • Hypospadias
  • Impotence of an Organic Origin
  • Infectious Penile Lesions
  • Paraphimosis
  • Peyronie's Disease
  • Phimosis
  • Vascular Disorders

Differential Diagnosis

  • Bowen's disease
  • Cancer
  • Congenital deformities of the penis
  • Genital infection and inflammation
  • Impotence
  • Psychological impotence

Specialists

  • Dermatologist
  • Internal Medicine Physician
  • Psychiatrist
  • Urologist

Comorbid Conditions

  • Impotence
  • Kidney disease
  • Psychiatric disorders

Factors Influencing Duration

Length of disability may be influenced by type of disorder, method of treatment, individual's job responsibilities, individual's response to treatment, age, or the presence of complications.

Medical Codes

ICD-9-CM:
607 - Disorders of Penis
607.0 - Disorders of Penis, Leukoplakia of Penis; Kraurosis of Penis
607.1 - Disorders of Penis, Balanoposthitis; Balanitis
607.2 - Disorders of Penis, Inflammatory Disorders of Penis, Other; Abscess of Corpus Cavernosum or Penis; Boil of Corpus Cavernosum or Penis; Carbuncle of Corpus Cavernosum or Penis; Cellulitis of Corpus Cavernosum or Penis; Cavernitis (Penis)
607.3 - Disorders of Penis, Priapism; Painful Erection
607.8 - Disorders of Penis, Other
607.81 - Disorders of Penis, Other, Balanitis Xerotica Obliterans; Induratio Penis Plastica
607.82 - Vascular Disorders of Penis; Embolism of Corpus Cavernosum or Penis; Hematoma (nontraumatic) of Corpus Cavernosum or Penis; Hemorrhage of Corpus Cavernosum or Penis; Thrombosis of Corpus Cavernosum or Penis
607.83 - Disorders of Penis, Other, Edema of Penis
607.84 - Disorders of Penis, Other, Impotence of Organic Origin
607.85 - Disorders of Penis, Other, Peyronies Disease
607.89 - Other; Atrophy of Corpus Cavernosum or Penis; Fibrosis of Corpus Cavernosum or Penis; Hypertrophy of Corpus Cavernosum or Penis; Ulcer (Chronic) of Corpus Cavernosum or Penis
607.9 - Unspecified Disorder of Penis

Overview

Disorders that affect the penis include balanitis xerotica obliterans, balanoposthitis, erythroplasia, infectious penile lesions, phimosis, paraphimosis, hypospadias, epispadias, vascular disorders, Peyronie's disease, impotence of an organic origin, genital warts (condyloma acuminatum), cancer of the penis, and other conditions such as fibrosis, and ulcers.

Balanitis xerotica obliterans results from chronic inflammation of the head of the penis (glans). It presents as a blanched area near the tip of the penis that surrounds and often constricts the urinary passage (meatus).

Balanoposthitis is caused by bacterial and yeast infections beneath the loose fold of skin covering the end of the penis (foreskin of the penis) of the uncircumcised male.

Erythroplasia of Queyrat is common in uncircumcised men. It presents as reddish and velvety pigmentation on the glans. It is a premalignant lesion invading only the local tissues.

Rare infectious penile lesions include herpes zoster, TB, and fungal (mycotic) infections.

Phimosis is the most common form of penile malformation and refers to an abnormally tight foreskin. One is unable to retract the foreskin over the head of the penis. This condition can cause urination difficulty as well as painful erections. Phimosis prevents proper cleaning of the glans, leading to balanitis. It is also associated with an increased risk of penile cancer.

Paraphimosis often occurs as a complication of phimosis. Although the foreskin retracts at erection, it is too tight to move back over the glans. The penis becomes constricted, causing painful swelling of the glans and diminished blood flow. This is a medical emergency, as the glans can become gangrenous. Paraphimosis may cause urinary retention.

Hypospadias occurs when the urethra opens on the inferior (ventral) surface of the penis.

Epispadias occurs when the urethral opening is on the dorsal surface of the penis. This condition is rare.

Vascular disorders of the penis include the obstruction of a vessel by a blood clot (thrombosis or embolism), a localized swelling and mass of blood caused by a broken blood vessel (hematoma), or excessive bleeding (hemorrhage).

In Peyronie's disease, strands of dense, fibrous tissue form within the penis. This fibrosis causes the penis to curve during erection, interfering with intercourse. Peyronie's disease can also prevent erection distal to the area of fibrosis and can cause impotence. The fibrous areas have a gritty, bulky feel on palpation.

Painful and prolonged erection of the penis (priapism) is a dangerous condition requiring emergency treatment. It occurs when blood fails to drain from the spongy tissue of the penis, keeping the penis erect. Causes of priapism include damage to the nerves that control the blood supply to the penis, blood diseases that cause abnormal clotting of blood in the penis (leukemia, sickle cell anemia), testosterone replacement, infection, or inflammation that may block the normal outflow of blood from the penis (prostatitis, urethritis).

Condyloma acuminatum is a viral infection that may be transmitted during sexual intercourse. The infection is caused by the human papillomavirus (HPV) type 6 or 11. The lesions may be single or multiple and can involve the inner surface of the prepuce.

Cancer of the penis is rare and is much more common in uncircumcised men who practice poor hygiene.

Source: Medical Disability Advisor



Diagnosis

History: The individual may report pain in the flaccid penis, usually caused by inflammation (balanitis, phimosis), ulceration (balanoposthitis), swelling (vascular disorders), or painful enlargement of the glans constricted by paraphimosis. In an erect penis, pain may accompany curvature of the penis in Peyronie's disease, or the prolonged painful erection of priapism. Some individuals may notice soft, flat warts (condyloma acuminatum) on the penis. Redness and velvety pigmentation may be associated with erythroplasia. Hypospadias and epispadias can result in urinary incontinence.

Physical exam: The examination may reveal inflamed, moist glans (balanitis, phimosis). Ulcerated areas (balanoposthitis) may be identified. Swelling can be associated with vascular disorders or paraphimosis. In Peyronie's disease, the fibrous areas are gritty and bulky on palpation. Warts are soft and flat and may be difficult to distinguish visually (condyloma acuminatum). The foreskin is retracted to evaluate phimosis or paraphimosis. The dorsal (top) of the penile shaft is felt (palpated) for plaques of Peyronie's disease, and the ventral (bottom) surface for evidence of urethral tumors.

Tests: A culture may be necessary to identify the organism responsible for the inflammation or ulceration. To detect warts, the penis can be wrapped in a vinegar solution (acetic acid). Warts absorb solution at a different rate than surrounding skin, making them easily visible. Vascular function may be tested by injecting papaverine and phentolamine into the penis, causing an erection. Ultrasound may be performed to identify arterial abnormalities. These tests may be done to diagnose any of the penile disorders.

Source: Medical Disability Advisor



Treatment

Balanitis may be treated with a topical anti-inflammatory or antifungal cream, as well as by appropriate antibiotic therapy. If constriction has occurred, the opening of the penis may need to be surgically enlarged (meatotomy). Removing the foreskin (circumcision) will cure phimosis and paraphimosis, and prevent recurrence of balanitis when caused by an irritating foreskin. Circumcision also reduces the risk of cancer.

Treatment of priapism may involve spinal anesthesia or withdrawal of blood from the penis through a wide-bore needle. Additional surgery may be necessary. Treatment of certain underlying causes, such as sickle cell disease, may be effective. Drugs, such as antidepressants, antipsychotics, alpha-adrenergic blockers, antidiabetic agents, certain antihypertensive and anticoagulant drugs, as well as corticosteroids may be used to reduce priapism.

Antiviral agents may lessen the symptoms of herpes ulcers but will not cure the disease. Recurrence is expected, as the virus is difficult to eradicate. Gonorrhea and syphilis are effectively treated with appropriate antibiotic therapy. Genital warts may be removed by excision, electrocauterization, laser, use of cold (cryotherapy), or by the application of an acid solution (podophyllin).

Peyronie's disease may improve without treatment. Local injections of anti-inflammatory medications (corticosteroids) or calcium channel blockers are sometimes effective. If the condition persists, the thickened area can be surgically removed and replaced with a graft of normal tissue.

Phimosis and paraphimosis require circumcision. A preliminary dorsal slit may be required.

In epispadias, bladder outlet reconstruction may be required to achieve urinary control.

In hypospadias, functional and cosmetic correction may be needed. A new urethra (neourethra) may be constructed using penile shaft skin or foreskin.

Source: Medical Disability Advisor



Prognosis

Most disorders of the penis can be cured or improved through medication or surgical correction if done promptly and properly. Warts tend to recur; however, circumcision may prevent recurrence. Unfortunately, the surgical procedure used for Peyronie's disease may result in further scarring. Viral infections may return, as they can remain dormant in the body for many years. Treatment of priapism with drugs or surgery is usually successful. The prognosis for patients with epispadias and hypospadias is favorable but depends on the amount of the malformation and the extent of surgical reconstruction required.

Source: Medical Disability Advisor



Complications

Complications include the increased risk of penile cancer associated with phimosis, permanent damage to the penis, vascular disorders or priapism, impotence with Peyronie's disease, infertility, urine retention, urinary incontinence, and sexual dysfunction, as well as the transmission of herpes, gonorrhea, syphilis, or genital warts to a sexual partner.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations are dependent upon the type of disorder, method of treatment, individual's responsiveness, and individual's job responsibilities.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have a history of penile disorder?
  • Does individual report pain in the flaccid penis and redness of the glans, suggesting inflammation (balanitis and phimosis)?
  • Is there any ulceration (balanoposthitis)?
  • Does individual complain of tight foreskin that makes urination difficult and erection painful (phimosis)? Does individual report painful swelling of the glans after erection (paraphimosis)? Is erection itself painful, suggesting Peyronie's disease or priapism?
  • Are there warts (condyloma acuminatum) on the penis that are soft, flat, and do not itch? Was the penis wrapped in an acetic acid solution to make warts easily visible?
  • Is there urinary incontinence possibly due to hypospadias or epispadias?
  • If there is ulceration, was a culture taken to identify the organism responsible?
  • Was vascular function tested by inducing erection after penile injection of papaverine and phentolamine?
  • Was ultrasound done to identify arterial abnormalities?

Regarding treatment:

  • What disorder was diagnosed?
  • Was balanitis treated with anti-inflammatory or antifungal cream and appropriate antibiotic therapy?
  • If constriction occurred, was the opening of the penis surgically enlarged (meatotomy)?
  • Was phimosis or paraphimosis resolved by removing the foreskin (circumcision)?
  • Did individual require withdrawal of blood from the penis through a wide-bore needle to treat priapism?
  • Were underlying causes such as sickle cell disease identified and treated?
  • Does individual require medications such as antidepressants, antipsychotics, alpha-adrenergic blockers, antidiabetic agents, certain antihypertensive and anticoagulant drugs, as well as corticosteroids to reduce priapism?
  • Were genital warts removed by excision, electrocauterization, laser, cryotherapy, or by application of an acid solution (podophyllin)?
  • Were antiviral agents given to lessen the symptoms of herpes ulcers?
  • Were gonorrhea and syphilis treated with appropriate antibiotic therapy?
  • If individual has Peyronie's disease, were corticosteroids or calcium channel blockers required or did it resolve without treatment? If Peyronie's disease persists, will the thickened area be surgically removed and replaced with a graft of normal tissue?
  • For epispadias, was bladder outlet reconstruction done to achieve urinary control?
  • For hypospadias, were functional and cosmetic corrections required? Was construction of a new urethra using penile shaft skin or foreskin done?

Regarding prognosis:

  • Was medication or surgical correction done promptly and properly?
  • Have medications been taken exactly as prescribed?
  • Is this a recurrence of a viral infection such as with genital warts?
  • If individual has herpes, syphilis, or gonorrhea, does he continue to have contact with sexual partners who have not received treatment?
  • Did any complications arise because of surgery?
  • If individual has phimosis, did cancer develop?
  • Has permanent damage to the penis occurred because of vascular disorders?
  • Has individual developed impotence particularly with Peyronie's disease? Has individual developed infertility, urine retention, urinary incontinence, or sexual dysfunction?
  • Would individual benefit from psychological counseling to cope with the impact of the disorder?

Source: Medical Disability Advisor



References

General

Choe, Jong, and Hye Kim. "Phimosis, Adult Circumcision and Buried Penis." eMedicine. Eds. Leonard Gabriel Gomella, et al. 27 Aug. 2004. Medscape. 28 Dec. 2004 <http://emedicine.com/med/topic2873.htm>.

Keough, George C. "Balanitis Xerotica Obliterans." eMedicine. Eds. Mark Cobb, et al. 8 Sep. 2003. Medscape. 28 Dec. 2004 <http://emedicine.com/derm/topic46.htm>.

Source: Medical Disability Advisor






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