Paraphimosis

Paraphimosis is an uncommon^[1] medical condition where the foreskin becomes trapped behind the glans penis, and cannot be reduced (that is, pulled back to its normal flaccid position covering the glans penis). If this condition persists for several hours or there is any sign of a lack of blood flow, paraphimosis should be treated as a medical emergency, as it can result in gangrene or other serious complications.^[1]^[2]^[3]

Paraphimosis is usually caused by well-meaning medical professionals or parents who handle the foreskin improperly^[1]^[3]: The foreskin may be retracted during penile examination, penile cleaning, urethral catheterization, or cystoscopy; if the foreskin is left retracted for a long period of time, some of the foreskin tissue may become edematous (swollen with fluid), which makes subsequent reduction of the foreskin difficult.

Paraphimosis can be avoided by bringing the foreskin back into its reduced position after retraction is no longer necessary (for instance, after cleaning the glans penis or placing a Foley catheter). Phimosis (both pathologic and normal childhood physiologic forms) is a risk factor for paraphimosis, and consequently the foreskin should never be forcibly retracted;^[2] physiologic phimosis resolves naturally as a child matures, but it may be advisable to treat pathologic phimosis via long-term stretching or elective surgical techniques (such preputioplasty to loosen the pruptial orifice or circumcision to amputate the foreskin tissue partially or completely).

Paraphimosis can often be effectively treated by manual manipulation of the swollen foreskin tissue. This involves compressing the glans and moving the foreskin back to its normal position, perhaps with the aid of a lubricant and local anesthesia as necessary. If this fails, the tight edematous band of tissue can be relieved surgically with a dorsal slit.^[3]^[1] An alternative method, the Dundee technique, entails placing multiple punctures in the swollen foreskin with a fine needle, and then expressing the edema fluid by manual pressure. Treatment by circumcision may be elected as "a last resort, to be performed by a urologist".^[4] Other experts recommend delaying elective circumcision until after paraphimosis has been resolved.^[1]^[3]

References

^ ^a ^b ^c ^d ^e Jeffrey M Donohoe; Jason O Burnette; James A Brown (October 7, 2009). "Paraphimosis". eMedicine. Patients with severe paraphimosis that proves refractory to conservative therapy will require a bedside emergency dorsal slit procedure to save the penis. A formal circumcision can be performed in the operating room at a later date... At a later date, a formal circumcision can be performed as an outpatient procedure.{{cite web}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b Hina Z Ghory; Rahul Sharma (April 28, 2010). "Phimosis and Paraphimosis". eMedicine. Patients with phimosis, both physiologic and pathologic, are at risk for developing paraphimosis when the foreskin is forcibly retracted past the glans and/or the patient or caretaker forgets to replace the foreskin after retraction.{{cite web}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b ^c ^d Choe, J.M. (15 Dec. 2000). "Paraphimosis: Current Treatment Options". American Family Physician. If a severely constricting band of tissue precludes all forms of conservative or minimally invasive therapy, an emergency dorsal slit should be performed. This procedure should be performed with the use of a local anesthetic by a physician experienced with the technique... Circumcision, a definitive therapy, should be performed at a later date to prevent recurrent episodes, regardless of the method of reduction used. {{cite journal}}: Check date values in: |year= (help)CS1 maint: year (link)
^ Hina Z Ghory; Rahul Sharma (April 28, 2010). "Phimosis and Paraphimosis". eMedicine.{{cite web}}: CS1 maint: multiple names: authors list (link)

External links

Reduction of paraphimosis the simple way - the Dundee technique J.M.Reynard & J.M.Barua, British Journal of Urology, Volume 83, Number 7, Pages 859-860. (contains pictures of a medical procedure and penis)

[emedicine-donohoe-1] Jeffrey M Donohoe; Jason O Burnette; James A Brown (October 7, 2009). "Paraphimosis". eMedicine. Patients with severe paraphimosis that proves refractory to conservative therapy will require a bedside emergency dorsal slit procedure to save the penis. A formal circumcision can be performed in the operating room at a later date... At a later date, a formal circumcision can be performed as an outpatient procedure.{{cite web}}: CS1 maint: multiple names: authors list (link)

[emedicine-ghory-general-2] Hina Z Ghory; Rahul Sharma (April 28, 2010). "Phimosis and Paraphimosis". eMedicine. Patients with phimosis, both physiologic and pathologic, are at risk for developing paraphimosis when the foreskin is forcibly retracted past the glans and/or the patient or caretaker forgets to replace the foreskin after retraction.{{cite web}}: CS1 maint: multiple names: authors list (link)

[aafp-choe-3] Choe, J.M. (15 Dec. 2000). "Paraphimosis: Current Treatment Options". American Family Physician. If a severely constricting band of tissue precludes all forms of conservative or minimally invasive therapy, an emergency dorsal slit should be performed. This procedure should be performed with the use of a local anesthetic by a physician experienced with the technique... Circumcision, a definitive therapy, should be performed at a later date to prevent recurrent episodes, regardless of the method of reduction used. {{cite journal}}: Check date values in: |year= (help)CS1 maint: year (link)

[emedicine-ghory-treatment-4] Hina Z Ghory; Rahul Sharma (April 28, 2010). "Phimosis and Paraphimosis". eMedicine.{{cite web}}: CS1 maint: multiple names: authors list (link)

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References

External links