Paraphimosis

Abstract

Paraphimosis is one of the rare urologic emergencies that may be encountered by a general physician. It is diagnosed when the foreskin in an uncircumcised male becomes stuck behind the corona and forms a tight band of constricting tissue, which prevents its return to the natural position. Paraphimosis generally occurs after self-retraction for any reason. Typically, the foreskin is pulled back and inadvertently, the child, parent, or medical professional forgets to return the retracted foreskin to its original position, thereby causing the paraphimosis. A tight constricting band of tissue forms when the foreskin rests in the proximal position behind the corona for a lengthened period. Consequently, this constricting ring reduces blood and lymphatic flow to and from the prepuce and the glans penis. The goals of treatment are to reduce penile edema and the complete reduction of the paraphimosis. Glans edema may be reduced with constant circumferential manual pressure around the distal penis. Refractory paraphimosis may be treated with sugar, hyaluronidase, puncture, blood aspiration, and ultimately the dorsal slit technique. When initial attempts by the general practitioner at reduction are unsuccessful, prompt urologic consultation is warranted for more specialized treatment.