Phimosis

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

Dorsal Slit (Penis)

Source

Tintinalli