Paraphimosis

Question 1

What is paraphimosis?

Answer 1

Inability to pull foward a retracted foreskin over the glans penis

Question 2

What is paraphimosis most often caused by?

Answer 2

Tight constricting band as part of the foreskin the prevents the retraction over the glans

Question 3

What happens as the paraphimosis remains?

Answer 3

Glans becomes increasing oedamatous due to reduced venous return, leading to vascular engorgement of the distal penis and further oedema. If left untreated may lead to penile ischemia and worsening infection (incuding fourniers gangrene)

This is a urological emergency

Question 4

What are the risk factors for paraphimosis?

Answer 4

Phimosis
Urethral catheter (un-replaced foreskin)
Poor hygiene
Prior paraphimosis

Question 5

What are the clinical features of paraphimosis?

Answer 5

Progressive pain and swelling in the glans folowing retraction of thier foreskin and unable to retract - may have repeated admissions if underlying cause not been addresed.

Question 6

What is the management of paraphimosis?

Answer 6

Reduced as soon as possible

Give suitable analgesia prior to reduction - penile block via LA(without adrenaline) may be warrented

Once reduced ensure to arrange outpatient urgent follow up for definitive options (circumcision)

Question 7

What are the varoius techniques for reduction in paraphimosis?

Answer 7

Manual pressure to glans - lubricant as required

Dectrose-soaked gauze

Dundee technique - needle punctures into the glans

Question 8

What happens if manual reduction fails?

Answer 8

Dorsal slit or an emergency circumcision