II. Definition

  1. Foreskin stuck in retracted position
  2. Emergency condition due to Compartment Syndrome and risk of vascular compromise

III. Pathophysiology

  1. Foreskin forms tight circumferential band around base of glans penis
  2. Strangulates glans penis and obstructs arterial blood flow
  3. Necrosis of glans penis results if Paraphymosis not treated emergently

IV. Causes

  1. Forceful retraction of foreskin in infants
  2. Chronic Balanitis
  3. Indwelling catheter

V. Signs

  1. Glans penis and distal penile shaft swollen, red and tender to palpation

VI. Management

  1. Emergent Urology Consultation for immediate reduction
  2. Adequate anesthesia
    1. Dorsal Penile Nerve Block
    2. Conscious Sedation
  3. Preparation
    1. Wrap glans penis in 2x2 gauze (or hold manual pressure on glans) for five minutes
    2. Decreases glans penis edema
  4. Manual Reduction
    1. Hold foreskin with both hands
    2. Thumbs used to push glans penis through Paraphymosis
    3. Consider lubrication (e.g. Lidocaine Jelly) of glans prior to attempted reeduction
  5. Refractory Paraphymosis measures
    1. Anesthesia
      1. Dorsal Penile Nerve Block or
      2. Conscious Sedation
    2. Needle decompress foreskin
      1. Insert 21 gauge needle in several locations through foreskin to try to reduce edema
    3. Hyaluronidase injection
      1. Inject hyaluronidase into foreskin
    4. Dorsal slit
      1. Indicated if refractory to all other reduction methods above
      2. Cut a dorsal slit of foreskin to allow foreskin reduction
      3. Commits patient to Circumcision

VII. Prevention

VIII. References

  1. Majoewsky (2012) EM:Rap-C3 2(9): 2
  2. Walsh (1998) Campbell's Urology, Saunders, p. 3330-1
  3. Lundquist (2001) Emerg Med Clin North Am 19(3):529-46 [PubMed]

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Ontology: Paraphimosis (C0030483)

Definition (NCI) A condition in which the foreskin of an uncircumcised male is retracted and cannot be pulled back over the glans penis. It results in painful swelling of the glans penis and, if is not corrected, may lead to gangrene.
Definition (MSH) A condition in which the FORESKIN, once retracted, cannot return to its original position. If this condition persists, it can lead to painful constriction of GLANS PENIS, swelling, and impaired blood flow to the penis.
Concepts Disease or Syndrome (T047)
MSH D010263
ICD10 N47.2
SnomedCT 155922002, 13758004
English Paraphimoses, Paraphimosis, paraphimosis (diagnosis), paraphimosis, Paraphimosis [Disease/Finding], Paraphimosis (disorder)
Swedish Parafimos
Czech parafimóza, Parafimóza
Finnish Parafimoosi
Russian PARAFIMOZ, ПАРАФИМОЗ
French Paraphimose, Paraphimosis
Dutch paraphimosis, Parafimose, Paraphimosis
Japanese 嵌頓包茎, カントンホウケイ
Polish Załupek
Hungarian ((paraphimosis))
Norwegian Parafimose, Spansk krage
Spanish parafimosis (trastorno), parafimosis, Parafimosis
German Capistratio, Paraphimose, Kapistration, Spanischer Kragen
Italian Parafimosi
Portuguese Parafimose