Paraphimosis

Review literature: (Choe, 2000).

Definition of Paraphimosis

Paraphimosis is a urological emergency with a prepuce being trapped behind the glans penis. Major risk factor is phimosis. The foreskin with phimosis leads to a circular narrowing of the base of the glans with swelling and decreased blood flow to the glans [fig. paraphimose].

Synonym: Spanish collar.

fig. paraphimosis before and after reposition

Paraphimosis: before (left) and after (right) reposition of the foreskin. By courtesy, Prof. Dr. R. Harzmann, Augsburg.

Signs and Symptoms of Paraphimosis

Painful edema of the foreskin, ischemic discoloration of the glans.

Treatment of Paraphimosis

Reduction of the Prepuce

After local anesthesia (penile block), manual compression of the glans and reduction of the foreskin is done. In children, general anesthesia may be appropriate.

If a reduction is not possible, it may be possible by using cooling and osmotic mechanisms (application of sugar, injecting of hyalorone). These published techniques are rarely applied in practice.

Definitely, the reduction of the foreskin is achieved with a longitudinal dorsal incision of the phimotic ring [fig. dorsal incision in paraphimosis]. After reduction, the wound is closed with a transverse suture.