Penile dorsal slit

Indications

1. relieve paraphimosis that is strangulating the glans
2. phimosis causing urinary retention

Contraindications

1. no absolute contraindications
   1. consult urologist prior to procedure if there is evidence of overlying infection, patients who are immunocompromised, or in those with coagulation disorder

Equipment Needed

1. betadine
2. sterile gloves/drape
3. local anesthesia
4. 27 gauge needle
5. 3cc syringe
6. straight hemostats or kelly clamp
7. iris scissors
8. vicryl suture (3-0 or 4-0)
9. needle driver
10. gauze

Procedure

1. prep and drape penis in sterile fashion
2. raise a wheal of anesthesia in the foreskin, just proximal to the glans on the dorsal aspect of the penis (27-gauge needle)
3. Extend the injection along the longitudinal axis distally to the tip of the foreskin
4. After 4 min, check to make certain the anesthesia is effective
5. Slide the hemostats along the space between the foreskin and the glans, and gently open, forming a tract.
6. Remove the hemostats, then replace with one tip between the foreskin and glans, and one tip outside the foreskin, straddling the region of anesthesia. Make certain the tip of the hemostats is not in the urethral meatus.
7. Close the hemostat over the region of anesthesia and keep clamped for 10 min.
8. Remove the hemostat, and cut the serrated clamped tissue with the scissors.
   1. (If the skin edges continue to ooze, a running stitch using a vicryl suture can be placed on each side)
9. Retract the foreskin and clean the glans
   1. (Place a Foley catheter when indicated)

Complications

1. bleeding
2. pain
3. infection
4. damage to glans or urethra

Source

Emedicine

adapted from donaldson