Related Subjects:
|Testicular Torsion
|Paraphimosis
|Hypospadias
|Phimosis
|Balanitis (Children)
⚠️ It is crucial to return the foreskin to its normal position after catheterisation or any procedure.
🚨 Paraphimosis is a urological emergency - failure to relieve the constricting band may cause glans necrosis.
| 🚑 Severe Paraphimosis: Urgent Urology Help if Not Quickly Reduced |
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- 💊 Pain Relief: Give strong analgesia and/or sedation before reduction (low threshold for opioids).
- 🖐️ Manual Reduction: Compress glans firmly with gauze or compression dressing. Use lubricant/anaesthetic jelly. Apply ice to reduce swelling before pulling foreskin back.
- 🧂 Osmotic Reduction: Apply gauze soaked in 50% dextrose + 2% lidocaine jelly, cover with condom/condom Foley, wait 1h, then attempt reduction. Simple sugar paste can also help draw out oedema.
- 🔪 Surgical Intervention: If manual methods fail ➝ urgent dorsal slit to relieve constriction. Circumcision prevents recurrence (esp. if recurrent paraphimosis/phimosis).
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ℹ️ About
- Paraphimosis = foreskin retracted behind the glans and stuck, unable to be replaced.
➡️ Often iatrogenic after catheterisation or cleaning if foreskin not repositioned.
🧾 Aetiology
- Occurs at any age if foreskin retracted and left behind glans.
- 💉 Iatrogenic: catheterisation or cleaning.
- ❤️ Vigorous sexual activity.
- 🩺 Chronic balanoposthitis (esp. diabetics).
- ⚡ Penile piercing or trauma.
- ⛓️ Repeated forcible retraction leading to scarring.
👨⚕️ Clinical
- Acute penile pain, swelling, and oedema around constricting band.
- Infants may present with irritability rather than pain.
- Carers may notice it incidentally in debilitated patients.
- 🚨 Severe cases ➝ glans becomes blue/black (ischaemia/necrosis).
🛠️ Management
- Most common in older men ➝ especially after catheterisation when foreskin not replaced.
- 🧊 Ice + manual compression (5–30 min) with lubricant often works.
- 🧴 Saline/dextrose-soaked swabs reduce oedema before reduction.
- 👶 In children, hyaluronidase injection into oedematous prepuce can help.
- 🚑 If unsuccessful ➝ urgent urology: dorsal slit ± circumcision.
- Catheter can be reinserted after reduction if still indicated.
| 📊 Comparison Between Phimosis and Paraphimosis |
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| Criteria |
Phimosis |
Paraphimosis |
| Definition |
🚫 Inability to retract foreskin over glans |
🚨 Retracted foreskin stuck behind glans, causing constriction |
| Causes |
Congenital, poor hygiene, recurrent infections, scarring |
Forceful retraction, catheterisation, trauma |
| Clinical Features |
Tight foreskin, ballooning during urination, discomfort |
Pain, swelling, erythema, venous congestion, ischaemia |
| Complications |
Urinary retention, recurrent balanitis, ↑ risk penile Ca |
Glans ischaemia, necrosis, gangrene |
| Management |
Topical steroids, gentle stretching, circumcision |
Manual/ice/osmotic reduction → dorsal slit/circumcision if fails |
Case – Paraphimosis (urological emergency)
A 62-year-old man presents with a painful, swollen glans and a tight foreskin retracted behind the corona after catheter care; the constricting phimotic ring has caused venous/lymphatic congestion → oedema → risk of ischaemia. Give strong analgesia (consider penile block), then attempt manual reduction: ice/anaesthetic gel, compress oedema (elastic wrap for 5–10 min, or osmotic agents such as granulated sugar/50% dextrose), then push the glans in while pulling the foreskin forward. If unsuccessful, perform puncture/drainage of oedema with multiple fine-needle stabs or a small dorsal slit (sterile technique) and reduce; involve urology urgently if ischaemia, necrosis, or failed bedside reduction. After reduction, do not re-retract the foreskin; treat precipitating causes (catheter care, balanitis), prescribe analgesia ± antibiotics if infected, and arrange definitive circumcision (esp. with recurrent episodes or lichen sclerosus). Document times (onset, reduction) and provide written safety-netting for recurrence or worsening pain/colour change.
