Paraphimosis
Background
- Retracted foreskin becomes trapped behind glans
- Acts as constricting band[1]
- May result in glans necrosis as venous engorgement leads to arterial compromise
- Urologic emergency
Clinical Features
- Pain
- Erythema
- Swelling distal to constricting ring of foreskin
Differential Diagnosis
Non-Traumatic penile diagnoses
Penile trauma types
Evaluation
- Typically a clinical diagnosis
Management
- Reduction
- Perform as soon as possible
- Consider penile block, local anesthetic cream (EMLA) or procedural sedation
- Use bag of ice (3min intervals) or manual compression before attempting reduction
- Consider granulated sugar (as an osmotic agent)
- Wrap glans with 2x2-in. elastic bandage for 5min
- 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 (3-5mm deep) in foreskin (expresses glans edema fluid) and then perform compression
- Inject hyaluronidase into the swollen foreskin to decrease edema
- Can also use several evenly spaced, babcock (noncrushing) clamps around foreskin, followed by gentle traction to pull phimotic ring over the glans
- Dorsal Slit indicated if evidence of impaired perfusion and urologist unavailable
Disposition
- Refer all cases to urology to determine need for circumcision