Penile dorsal slit: Difference between revisions
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==Indications== | ==Indications== | ||
*Relieve [[paraphimosis]] | |||
**After failure of non-invasive reduction | |||
**Emergent urology consult not available | |||
*[[Phimosis]] causing urinary retention | |||
==Contraindications== | ==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== | ==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== | ==Procedure== | ||
# | #Prep and drape penis in sterile fashion | ||
# raise a wheal of | #Using a 27 gauge needle, raise a wheal of anesthetic in the foreskin | ||
# Extend the injection along the longitudinal axis | #*Just proximal to the glans on the dorsal aspect of the penis | ||
# After 4 min, check | #Extend the injection along the longitudinal axis until entire foreskin is anesthetized | ||
# Slide | #After 4 min, check effectiveness of anesthetic | ||
# Remove | #Slide closed hemostat between dorsal penis and foreskin | ||
# Close | #Gently open hemostat to create a tract | ||
# Remove | #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== | ==Complications== | ||
*Bleeding | |||
*Pain | |||
*Infection | |||
*Damage to glans or urethra | |||
== | ==See Also== | ||
*[[Paraphimosis Reduction]] | |||
*[[Phimosis]] | |||
*[[Paraphimosis]] | |||
==References== | |||
<references/> | |||
Emedicine | Emedicine | ||
[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category: | [[Category:Urology]] |
Revision as of 20:42, 15 May 2019
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
- 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
References
Emedicine