Paraphimosis

Background

  • Foreskin trapped behind glans
  • Urologic emergency
    • May result in glans necrosis if not reduced due to venous engorgement causing arterial compromise

Clinical Features

Paraphimosis with non-retractable foreskin and distal swelling
  • Pain
  • Erythema
  • Swelling distal to constricting ring of foreskin

Differential Diagnosis

Non-Traumatic penile diagnoses

Penile trauma

Evaluation

  • Typically a clinical diagnosis

Management

  • 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
      • Consider granulated sugar (as an osmotic agent)
      • Wrap glans with 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 evidence of impaired perfusion and urologist unavailable

Disposition

  • Refer all cases to urology to determine need for circumcision

See Also

References