Paraphimosis: Difference between revisions
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*Reduction | *Reduction | ||
**Perform as soon as possible | **Perform as soon as possible | ||
**Consider penile block or procedural sedation | **Consider penile block, local anesthetic cream (EMLA) or procedural sedation | ||
**Use bag of ice (3min intervals) or manual compression before attempting reduction | **Use bag of ice (3min intervals) or manual compression before attempting reduction | ||
***Wrap glans w/ 2x2-in. elastic bandage for 5min | |||
**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 22-25ga needle to make multiple punctures in foreskin and then perform compression | **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 | **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 (Penis)|Dorsal Slit]] indicated if e/o impaired perfusion and urologist unavailable | **[[Dorsal Slit (Penis)|Dorsal Slit]] indicated if e/o impaired perfusion and urologist unavailable | ||
Revision as of 03:26, 2 January 2014
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, local anesthetic cream (EMLA) or procedural sedation
- Use bag of ice (3min intervals) or manual compression before attempting reduction
- Wrap glans w/ 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 e/o impaired perfusion and urologist unavailable
Disposition
- Refer all cases to urology to determine need for circumcision
See Also
Source
Tintinalli