Paraphimosis Flashcards
What is paraphimosis?
Inability to pull forward a retracted foreskin.
Causes
Most often due to presence of a tight constricting band as part of the foreskin that prevents the retraction over the glans.
What happens as the paraphimosis progresses?
The glans becomes increasingly oedematous due to reduced venous return.
This leads to vascular engorgement of the distal penis and further oedema.
What happens if it is left untreated?
Penile ischaemia and worsening infection which can cause Fournier’s gangrene.
This means that is a urological emergency.
RIsk factors
Phimosis
Indwelling urethral catheters
Poor hygiene
Prior paraphimosis
Clinical features
Progressive pain and swelling in glans or distal prepuce
Unable to retract in back over glans.
Management
Should be reduced as soon as possible
Delays can cause serious problems
Ensure suitable analgesia
Sometimes a penile lock via local anaesthetic without adrenaline may be warranted.
Once reduced considered circumcision.
Various techniques to reduce it
Manual pressure
Application of dextrose-soaked gauze
Dundee Technique
Explain Manual pressure technique.
Put manual pressure on the glans
Thsi can aid to reduce oedema by squeezing it gently.
Then apply some force to the glans to reduce it into the prepuce by lubricant jelly to aid.
Explain application of dextrose-soaked gauze
This acts as an osmotic effect to draw fluid out of the glans to reduce oedema.
This allows for similar glans reduction as manual pressure.
It can also be done with ice packs
Explain the dundee technique
Involves the use of needle punctures into the glans penis.
Squeeze the area then to allow drainage of oedematous fluid.
Then reduce the glans.
If manual reduction fails, what can be done?
Dorsal slit of prepuce at 12o clock position.
Emergency circumcision might be required.
