View source for Penile dorsal slit

==Indications==
*Relieve [[paraphimosis]] 
**After failure of non-invasive reduction
**Emergent urology consult not available
*[[Phimosis]] causing urinary retention

==Contraindications==
*No absolute contraindications
*Should be performed by urologist if consultation is immediately available
*Caution when:
**Evidence of overlying infection
**Patient immune compromised
**Patient has coagulation disorder

==Equipment Needed==
*Betadine or other antiseptic prep solution
*Sterile gloves and drape 
*Local anesthetic
*27 gauge needle
*3cc syringe
*Straight hemostats or Kelly clamp
*Iris scissors
*Vicryl suture (3-0 or 4-0)
*Needle driver
*Gauze

==Procedure==
[[File:Dorsal slit.jpg|thumb|Single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue.]]
#Prep and drape penis in sterile fashion
#Using a 27 gauge needle, raise a wheal of anesthetic in the foreskin
#*Just proximal to the glans on the dorsal aspect of the penis
#Extend the injection along the longitudinal axis until entire foreskin is anesthetized
#After 4 min, check effectiveness of anesthetic
#Slide closed hemostat between dorsal penis and foreskin
#Gently open hemostat to create a tract
#Remove hemostat
#Open hemostat and insert bottom prong along previously created tract with top prong above the foreskin
#*Carefully ensure that hemostat is not in urethral meatus
#Close hemostat to crush foreskin tissue
#Leave hemostat in place for 10 minutes
#Remove hemostat
#Use iris scissors to cut crushed tissue
#Use vicryl to place a running stitch along cut ends of foreskin if oozing is excessive or persistent
#Clean glans
#Place Foley catheter if needed

==Complications==
*Bleeding
*Pain
*Infection
*Damage to glans or urethra

==See Also==
*[[Paraphimosis Reduction]]
*[[Phimosis]]
*[[Paraphimosis]]

==References==
<references/>
Emedicine

[[Category:Procedures]]
[[Category:Urology]]