Makindo Medical Notes

Paraphimosis is an emergency as failure to return the foreskin to in front of the gland can constrict the shaft of the opens and cause ischaemia. Try to reduce it and if fails call urology.

Phimosis

• Patient History:
  • Ask about symptoms such as pain, difficulty urinating, ballooning of the foreskin during micturition, or recurrent infections.
  • Inquire about discomfort or pain during sexual activity, as phimosis can lead to difficulties with intercourse.
  • Determine if there is a history of recurrent balanitis (inflammation of the foreskin or glans).
• Physical Examination:
  • Foreskin Retraction: Attempt gentle retraction of the foreskin. Avoid forceful retraction as it can cause scarring or trauma. True phimosis will prevent full retraction.
  • Observation of Ballooning: Check for ballooning of the foreskin during urination, which may indicate obstruction.
  • Skin Condition: Look for any scarring, thickening, or white plaques, which may suggest lichen sclerosus (a cause of pathological phimosis).
  • Signs of Infection: Observe for erythema, swelling, or purulent discharge indicating balanitis.
  • Age Consideration: Physiological (normal) phimosis is common in younger children and usually resolves with age, while adult cases may signify a pathological condition.

Paraphimosis

• Patient History:
  • Commonly acute onset following activities such as catheterization, sexual activity, or hygiene routines where the foreskin was retracted and not returned to its normal position.
  • Ask about pain severity and any urination difficulty, as paraphimosis can lead to urinary retention.
• Physical Examination:
  • Swelling and Constriction Band: Look for swelling of the glans with a visible tight, constricting band of foreskin at the base, creating a "doughnut" appearance.
  • Glans Color: Assess for colour changes; severe constriction may impair blood flow, turning the glans purple or cyanotic, indicating compromised blood supply.
  • Edema and Tenderness: Note any significant edema, tenderness, or erythema of the foreskin and glans.
  • Urgency: Paraphimosis is a urological emergency. Immediate intervention is required if ischaemia is suspected to prevent tissue necrosis.

Key Considerations

• Severity and Urgency: Paraphimosis requires urgent intervention to restore blood flow, whereas phimosis, unless symptomatic or infected, may often be managed conservatively.
• Management Readiness: Be prepared to initiate immediate reduction techniques for paraphimosis. Phimosis assessment often involves planning for conservative or surgical management, especially in chronic cases.

Comparison Between Phimosis and Paraphimosis