Phimosis: Difference between revisions
(Created page with "==Phimosis== ===Background=== *Unable to retract foreskin over glans *Most uncircumcised infants have normal, physiologic phimosis **Nearly all cases resolve by 5yr of age *Only ...") |
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===Treatment=== | ===Treatment=== | ||
*Dilation of foreskin and foley cathether if | *Dilation of foreskin and foley cathether if urinary retention is present | ||
===Disposition=== | ===Disposition=== | ||
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*Urologic emergency | *Urologic emergency | ||
**May result in necrosis of glans if not reduced | **May result in necrosis of glans if not reduced | ||
===Diagnosis=== | ===Diagnosis=== | ||
*Pain, erythema, swelling distal to constricting ring of foreskin | *Pain, erythema, swelling distal to constricting ring of foreskin | ||
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**Use bag of ice (3min intervals) or manual compression before attempting reduction | **Use bag of ice (3min intervals) or manual compression before attempting reduction | ||
**Use thumbs to push the glans into the foreskin while index fingers pull foreskin back into normal position | **Use thumbs to push the glans into the foreskin while index fingers pull foreskin back into normal position | ||
*If fails obtain emergent urology consult and/or perform the following | *If fails obtain emergent urology consult and/or perform the following: | ||
**Use | **Use 22-25ga needle to make multiple punctures in foreskin and then perform compression | ||
**Inject hyaluronidase into the swollen foreskin to decrease edema | **Inject hyaluronidase into the swollen foreskin to decrease edema | ||
**[[Dorsal Slit (Penis)]] | **[[Dorsal Slit (Penis)]] indicated if e/o impaired perfusion and urologist unavailable | ||
===Disposition=== | ===Disposition=== | ||
Revision as of 19:53, 17 August 2011
Phimosis
Background
- Unable to retract foreskin over glans
- Most uncircumcised infants have normal, physiologic phimosis
- Nearly all cases resolve by 5yr of age
- Only emergency if causes acute urinary retention
Work-Up
- Ensure that pt able to urinate
Treatment
- Dilation of foreskin and foley cathether if urinary retention is present
Disposition
Discharge
Paraphimosis
Background
- Foreskin trapped behind glans
- Urologic emergency
- May result in necrosis of glans if not reduced
Diagnosis
- Pain, erythema, swelling distal to constricting ring of foreskin
Treatment
- Reduction
- Perform as soon as possible
- Consider penile block or procedural sedation
- Use bag of ice (3min intervals) or manual compression before attempting reduction
- Use thumbs to push the glans into the foreskin while index fingers pull foreskin back into normal position
- If fails obtain emergent urology consult and/or perform the following:
- Use 22-25ga needle to make multiple punctures in foreskin and then perform compression
- Inject hyaluronidase into the swollen foreskin to decrease edema
- Dorsal Slit (Penis) indicated if e/o impaired perfusion and urologist unavailable
Disposition
- Refer all cases to urology to determine need for circumcision
See Also
Source
Tintinalli