Paraphimosis

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Paraphimosis
File:Paraphimosis.jpg Paraphimosis
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Swelling of the glans penis, pain
Complications	Gangrene, urinary retention
Onset	Sudden
Duration	Until treated
Types	N/A
Causes	Foreskin trapped behind the glans
Risks	Catheterization, phimosis
Diagnosis	Based on physical examination
Differential diagnosis	Phimosis, balanitis
Prevention	Proper foreskin management
Treatment	Manual reduction, dorsal slit, circumcision
Medication	Analgesics, topical anesthetics
Prognosis	Good with treatment
Frequency	Common in uncircumcised males
Deaths	N/A

Paraphimosis

Paraphimosis is a urological emergency that occurs when the foreskin of the penis is retracted behind the glans (the head of the penis) and cannot be returned to its normal position. This condition leads to constriction and swelling of the glans penis, potentially compromising blood flow and resulting in severe pain and swelling. Paraphimosis is distinct from Phimosis, where the foreskin cannot be pulled back over the glans penis due to tightness.

Introduction

Paraphimosis often occurs due to improper handling during medical procedures, personal hygiene, or sexual activities. If left untreated, it can lead to serious complications, including gangrene of the penis due to restricted blood flow.

File:Illustration of male pubis and penis diseased with Syphilis Wellcome L0038209.jpg

Illustration depicting Paraphimosis condition.

Causes

• Retraction of the foreskin for medical examination or procedures without proper replacement.
• Vigorous sexual activity or masturbation.
• Chronic infections or inflammation of the foreskin.

Symptoms

Symptoms of paraphimosis include:

• Painful swelling of the glans penis.
• The foreskin is stuck behind the glans and cannot be moved forward.
• Discoloration of the glans penis, indicating compromised blood flow.
• Severe discomfort and difficulty urinating in advanced cases.

Diagnosis

Diagnosis is primarily based on physical examination. The distinctive appearance of the swollen glans with the foreskin trapped behind it is usually sufficient for diagnosis.

Treatment

Immediate treatment is necessary to relieve the constriction. Treatment options include:

• Manual reduction: Attempting to reduce the swelling and manually move the foreskin to its normal position. This may involve applying ice packs or sugar solutions to reduce swelling before attempting reduction.
• Puncture aspiration: Small punctures may be made in the foreskin to relieve fluid buildup and reduce swelling.
• Surgical intervention: In severe cases, or if manual reduction fails, circumcision or dorsal slit procedure may be required to relieve the constriction and prevent recurrence.

Complications

Untreated paraphimosis can lead to severe complications, such as:

• Reduced blood flow to the glans penis, leading to tissue damage.
• Gangrene of the penis in extreme cases.
• Infection due to compromised tissue integrity.

Prevention

Preventive measures include:

• Proper education on the importance of returning the foreskin to its normal position after retraction.
• Avoiding forceful retraction of the foreskin, especially in children.
• Prompt treatment of infections or inflammation of the foreskin to prevent scarring and tightness.

External Links

• Urology Care Foundation
• NHS: Paraphimosis