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Paraphimosis: Symptoms, Reduction and Surgical Treatment

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 at the base of the glans with swelling and decreased blood flow to the glans (Choe, 2000).

Signs and Symptoms of Paraphimosis

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

Treatment of Paraphimosis

Reduction of the Prepuce

Reduction of the prepuce is the initial treatment trial: after local anesthesia (penile block), manual compression of the glans and reduction of the forskin is done. In children, general anesthesia may be appropriate. If reduction is not possible, procede with dorsal incision.

Dorsal Incision

Dorsal incision (in local anesthesia) is the initial therapy of a paraphimosis, which cannot be reduced. The dorsal incision cuts the phimotic ring in longitudinal direction. After the incision, the prepuce should be retractable without resistance. Transverse suture of the dorsal incision closes the skin defect and helps in hemostasis [fig. dorsal incision]. Circumcision should be postponed until the edema of the prepuce has resolved.

Circumcision

Circumcision is used for primary treatment or after resolution of the inflammation after reduction.

References

Choe 2000 CHOE, J. M.: Paraphimosis: current treatment options.
In: Am Fam Physician
62 (2000), Nr. 12, S. 2623–6, 2628

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