Penile dorsal slit: Difference between revisions

(Created page with "==Indications== * relieve paraphimosis that is strangulating the glans * phimosis causing urinary retention ==Contraindications== * no absolute contraindications * consu...")
 
 
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==Indications==
==Indications==
 
*Relieve [[paraphimosis]]
 
**After failure of non-invasive reduction
* relieve paraphimosis that is strangulating the glans
**Emergent urology consult not available
* phimosis causing urinary retention
*[[Phimosis]] causing urinary retention


==Contraindications==
==Contraindications==
 
*No absolute contraindications
 
*Should be performed by urologist if consultation is immediately available
* no absolute contraindications
*Caution when:
* consult urologist prior to procedure if there is evidence of overlying infection, patients who are immunocompromised, or in those with coagulation disorder
**Evidence of overlying infection
**Patient immune compromised
**Patient has coagulation disorder


==Equipment Needed==
==Equipment Needed==
 
*Betadine or other antiseptic prep solution
 
*Sterile gloves and drape  
* betadine
*Local anesthetic
* sterile gloves/drape  
*27 gauge needle
* local anesthesia
*3cc syringe
* 27 gauge needle
*Straight hemostats or Kelly clamp
* 3cc syringe
*Iris scissors
* straight hemostats or kelly clamp
*Vicryl suture (3-0 or 4-0)
* iris scissors
*Needle driver
* vicryl suture (3-0 or 4-0)
*Gauze
* needle driver
* gauze


==Procedure==
==Procedure==
 
[[File:Dorsal slit.jpg|thumb|Single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue.]]
 
#Prep and drape penis in sterile fashion
1) prep and drape penis in sterile fashion
#Using a 27 gauge needle, raise a wheal of anesthetic in the foreskin
 
#*Just proximal to the glans on the dorsal aspect of the penis
2) raise a wheal of anesthesia in the foreskin, just proximal to the glans on the dorsal aspect of the penis (27-gauge needle)
#Extend the injection along the longitudinal axis until entire foreskin is anesthetized
 
#After 4 min, check effectiveness of anesthetic
3) Extend the injection along the longitudinal axis distally to the tip of the foreskin
#Slide closed hemostat between dorsal penis and foreskin
 
#Gently open hemostat to create a tract
4) After 4 min, check to make certain the anesthesia is effective
#Remove hemostat
 
#Open hemostat and insert bottom prong along previously created tract with top prong above the foreskin
5) Slide the hemostats along the space between the foreskin and the glans, and gently open, forming a tract.
#*Carefully ensure that hemostat is not in urethral meatus
 
#Close hemostat to crush foreskin tissue
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.
#Leave hemostat in place for 10 minutes
 
#Remove hemostat
7) Close the hemostat over the region of anesthesia and keep clamped for 10 min.
#Use iris scissors to cut crushed tissue
 
#Use vicryl to place a running stitch along cut ends of foreskin if oozing is excessive or persistent
8) Remove the hemostat, and cut the serrated clamped tissue with the scissors.
#Clean glans
 
#Place Foley catheter if needed
(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  
 
(Place a Foley catheter when indicated)
 


==Complications==
==Complications==
*Bleeding
*Pain
*Infection
*Damage to glans or urethra


==See Also==
*[[Paraphimosis Reduction]]
*[[Phimosis]]
*[[Paraphimosis]]


* bleeding
==References==
* pain
<references/>
* infection
* damage to glans or urethra
 
==Source==
 
 
Emedicine
Emedicine
adapted from donaldson


[[Category:Procedures]]
[[Category:Procedures]]
[[Category:Urology]]

Latest revision as of 06:22, 8 May 2021

Indications

  • Relieve paraphimosis
    • After failure of non-invasive reduction
    • Emergent urology consult not available
  • Phimosis causing urinary retention

Contraindications

  • No absolute contraindications
  • Should be performed by urologist if consultation is immediately available
  • Caution when:
    • Evidence of overlying infection
    • Patient immune compromised
    • Patient has coagulation disorder

Equipment Needed

  • Betadine or other antiseptic prep solution
  • Sterile gloves and drape
  • Local anesthetic
  • 27 gauge needle
  • 3cc syringe
  • Straight hemostats or Kelly clamp
  • Iris scissors
  • Vicryl suture (3-0 or 4-0)
  • Needle driver
  • Gauze

Procedure

Single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue.
  1. Prep and drape penis in sterile fashion
  2. Using a 27 gauge needle, raise a wheal of anesthetic in the foreskin
    • Just proximal to the glans on the dorsal aspect of the penis
  3. Extend the injection along the longitudinal axis until entire foreskin is anesthetized
  4. After 4 min, check effectiveness of anesthetic
  5. Slide closed hemostat between dorsal penis and foreskin
  6. Gently open hemostat to create a tract
  7. Remove hemostat
  8. Open hemostat and insert bottom prong along previously created tract with top prong above the foreskin
    • Carefully ensure that hemostat is not in urethral meatus
  9. Close hemostat to crush foreskin tissue
  10. Leave hemostat in place for 10 minutes
  11. Remove hemostat
  12. Use iris scissors to cut crushed tissue
  13. Use vicryl to place a running stitch along cut ends of foreskin if oozing is excessive or persistent
  14. Clean glans
  15. Place Foley catheter if needed

Complications

  • Bleeding
  • Pain
  • Infection
  • Damage to glans or urethra

See Also

References

Emedicine

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