Paraphimosis

• Overview:

  • Inability to pull forward a retracted foreskin over the glans penis
  • Most often caused by a tight constricting band as part of the foreskin
  • The glans becomes increasingly oedematous due to reduced vascular return
  • If untreated may lead to penile ischaemia and worsening infection including Fournier's gangrene
  • Urological emergency
• Risk factors:

  • Phimosis
  • Indwelling catheter (unreplaced foreskin)
  • Poor hygiene
  • Prior paraphimosis
• Clinical features:

  • Progressive pain and swelling in the glans or distal foreskin following retraction of the foreskin, and being unable to retract it back over the glans
  • Patient may have repeated admissions if the underlying cause has not been addressed
• Management:

  • Prior to reduction, ensure suitable analgesia - penile block via local anaesthetic may be needed
  • Once reduced ensure definitive management (such as circumcision) is arranged urgently as an outpatient
  • Manual pressure to the glans using lubricant
  • Application of dextrose soaked gauze - draws fluid out the glans and then manually reduce
  • Dundee technique - needle puncture into the glans penis and squeeze out fluid
  • If the above methods fail then a dorsal slit (of the constricting band) or emergency circumcision may be needed
•  It may occur at any age, but is particularly common in elderly men, in whom the foreskin is not correctly pulled forwards after retraction for catheterisation or washing the glans.