PARAPHIMOSIS

Question 1

Pathophysiology

Answer 1

Proximal foreskin cannot be reduced to normal position covering the penis -> Results in distal venous congestion and swelling -> arterial compression, penile necrosis, and gangrene

Question 2

Etiology

Answer 2

infection, trauma, hair tourniquets, masturbation, foreign body

Question 3

Management

Answer 3

Pain control with analgesics, procedural sedation or dorsal nerve block
Reduce edema using an ice pack or a gauze soaked in mixture of 50cc of D50 and 2% lidocaine jelly placed on glans of penis (not if < 3 mos of age)
Use gauze to grip the penis, then with the tip of one or both thumbs push the glans through the foreskin opening while using your index and middle fingers to pull distally on the retracted foreskin to slide it back over the glans
If unsuccessful then Urology consult
Any evidence of cellulitis, necrosis, needs hospital admission, IV antibiotics, and Urology consult