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