Paraphimosis

Question 1

What is Paraphimosis?

Answer 1

• inability to pull forward a retracted foreskin over the glans penis.

Question 2

What is the Px of paraphimosis?

Answer 2

1. presence of a tight constricting band as part of the foreskin that prevents the retraction over the glans
2. glans becomes oedematous due to reduced venous return
3. vascular engorgement of the distal penis

Question 3

When does the foreskin spontaneously retract?

Answer 3

• >2
• Does not require manipulation

Question 4

What are the cx of untreated paraphimosis?

Answer 4

• Penile ischaemia
• worsening infection
• Fournier’s gangrene

Question 5

What are the RF for paraphimosis?

Answer 5

• Phimosis
• indwelling catheter
• Poor hygiene
• Hx of paraphimosis
• Scarring of prepuce after repeated forcible retraction in an attempt to ‘cure’ a physiological phimosis
• Vigorous sexual activity
• Chronic balanoposthitis
• Penile piercing

Question 6

What is phimosis?

Answer 6

• non retractile foreskin
• Normal in babies and toddlers

Question 7

What are the clinical features of paraphimosis?

Answer 7

• progressive pain and swelling in the glans or distal prepuce, following retraction of their foreskin
• unable to retract in back over their glans
• pain on erection
• later stages, the glans may develop a blue or black colour due to necrosis

Question 8

How would you mx paraphimosis?

Answer 8

• LA penile block - before starting procedure
• Gentle compression with a saline-soaked swab followed by reduction of the prepuce over the glans
• dextrose-soaked gauze to act as an osmotic effect, drawing fluid out of the glans, reducing the oedema present
• Dundee Technique involves the use of needle punctures into the glans penis, squeezing the area to allow drainage of oedematous fluid
• dorsal slit (incision of the prepuce at the 12’o clock position) or an emergency circumcision may be required