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Paraphymosis

Definition
1. Foreskin stuck in retracted position
Pathophysiology
1. Foreskin strangulates glans penis
2. Untreated, will result in distal penis necrosis
Causes
1. Forceful retraction of foreskin in infants
2. Chronic Balanitis
3. Indwelling catheter
Management
1. Emergent Urology Consultation for immediate reduction
2. Adequate anesthesia
  1. Dorsal penile nerve block
  2. Conscious Sedation
3. Reduction Method 1
  1. Hold foreskin with both hands
  2. Thumbs used to push glans penis through paraphymosis
4. Reduction Method 2
  1. Wrap glans in 2x2 gauze for five minutes
  2. Decreases glans penis edema
5. Dorsal slit
  1. Indicated if refractory to reduction methods above
Prevention
1. Circumcision
References
1. Walsh (1998) Campbell's Urology, Saunders, p. 3330-1
2. Lundquist (2001) Emerg Med Clin North Am 19(3):529

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.