Paraphimosis is a urological emergency as failure to remove the constricting band of paraphimosis will result in necrosis of the glans.
- Paraphimosis: the foreskin becomes retracted behind the glans penis and cannot be reduced. This may occur after failing to pull the foreskin forward to its natural position after cleaning or catheterization
- Paraphimosis can be seen at all ages when the foreskin retracted
- May be iatrogenic during catheter change or cleaning
- Also seen after vigorous sexual activity
- Chronic balanoposthitis (typically in patients with diabetes)
- Penile piercing
- Scarring of the prepuce after repeated forcible retraction in an attempt to 'cure' a physiological phimosis
- A tight prepuce causes swelling when it is retracted.
- There is acute penile pain, swelling and discomfort
- Infants may present just with irritability
- There is oedema around the constricting band that is usually the prepuce
- A carer may discover the condition incidentally in a debilitated patient
- In later stages, the glans may develop a blue or black colour due to necrosis
- Paraphimosis is seen in all ages but often in older men and can be iatrogenic when the foreskin is not reduced following urinary catheterisation
- Removing the catheter usually helps with penile manipulation which involves reduction is with a very tight grip for 20-30 minutes with some ice and KY jelly to reduce inflammation and oedema.
- Gentle compression with a saline-soaked swab followed by reduction of the prepuce over the glans is usually successful. Gradual manual reduction of the prepuce over the glans is done by placing both index fingers on the dorsal border of the penis and thumbs on the glans. The glans is pushed back while the index fingers pull the prepuce back over the glans
- This technique can be facilitated by trying to achieve the reduction of swelling first. Ice may be applied. Manual compression is achieved by asking the patient to squeeze the glans for anything from 5 to 30 minutes or the doctor may do this if the patient cannot. Osmotic reduction involves the application of a swab soaked in 50% dextrose to the swollen area for an hour. If simple measures fail refer urgently to urology. Urgent surgical care is usually an emergency dorsal slit procedure and consideration for circumcision
- The catheter may then be replaced after successful reduction if the indication for it still remains.
- Injection of hyaluronidase into the oedematous prepuce can be useful in babies and children