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
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 21ga needle to make multiple punctures in foreskin and then perform compression
- Inject hyaluronidase into the swollen foreskin to decrease edema
- Dorsal Slit (Penis)
Disposition
- Refer all cases to urology to determine need for circumcision
See Also
Source
Tintinalli