Paraphismosis Flashcards
What is paraphimosis?
The inability to pull forward a retracted foreskin over the glans penis
What is paraphimosis most often caused by?
Presence of tight constricting band as part of foreskin that prevents retraction over glans
What happens is the paraphimosis remains?
The glans becomes increasingly oedematous due to reduced vascular return, leading to vascular engorgement of distal penis and further oedema
What can paraphimosis lead to if untreated?
- Penile ischaemia
- Worsening infection, including Fournier’s gangrene
What are the results of paraphimosis having severe consequences?
Is urological emergency that requires immediate reduction
What are the risk factors for paraphismosis?
- Phimosis
- Indwelling urethral catheter
- Poor hygiene
- Prior paraphimosis
What is the typical presentation of paraphimosis?
Progressive pain and swelling in glans or distal prepuce, following retraction of their foreskin, and being unable to retract it back over their glans
How should any paraphimosis be managed?
Reduced as soon as possible
What should be done prior to any reduction of paraphimosis?
Ensure suitable analgesia, a penile block via local anaesthetic (without adrenaline) may be needed in smoe cases
What should be done once paraphimosis is reduced?
Ensure definitive management is arranged urgently as outpatient
What may the definitive management of a paraphimosis require?
Circumcision
What techniques can be used to reduce paraphimosis?
- Manual pressure on glans, before applying force to glans to reduce it into prepuce
- Application of dextrose soaked gauze
- Dundee technique - involves use of of needle punctures into glans penis to allow drainage of oedematous fluid before attempting reductio n
What may be required if manual reduction of paraphimosis cant be done?
Dorsal slit or emergency circumcision
