Paraphimosis

Background

• Foreskin trapped behind glans
• Urologic emergency
  • May result in glans necrosis if not reduced due to venous engorgement causing arterial compromise

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 indicated if e/o impaired perfusion and urologist unavailable

Disposition

• Refer all cases to urology to determine need for circumcision

See Also

• Dorsal Slit (Penis)
• Phimosis

Source

Tintinalli