Paraphimosis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
[[File:PMC2791735 wjem-10-281f1.png|thumb|Paraphimosis with non-retractable foreskin and distal swelling ]] | [[File:PMC2791735 wjem-10-281f1.png|thumb|Paraphimosis with non-retractable foreskin and distal swelling ]] | ||
* | *Penile pain | ||
* | *Enlarged and erythematous glans<ref>Choe, J. (2000). Paraphimosis: Current treatment options. American Family Physician, 62(12):2623-2626.</ref> | ||
* | *Constricting band immediately behind glans<ref>Choe, J. (2000). Paraphimosis: Current treatment options. American Family Physician, 62(12):2623-2626.</ref> | ||
*Penile shaft flaccid<ref>Choe, J. (2000). Paraphimosis: Current treatment options. American Family Physician, 62(12):2623-2626.</ref> | |||
*Pediatric patients may present with obstructive urinary symptoms<ref>Choe, J. (2000). Paraphimosis: Current treatment options. American Family Physician, 62(12):2623-2626.</ref> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 19:49, 15 May 2019
Background
- Retracted foreskin becomes trapped behind glans
- Acts as constricting band[1]
- May result in glans necrosis as venous engorgement leads to arterial compromise
- Urologic emergency
Clinical Features
- Penile pain
- Enlarged and erythematous glans[2]
- Constricting band immediately behind glans[3]
- Penile shaft flaccid[4]
- Pediatric patients may present with obstructive urinary symptoms[5]
Differential Diagnosis
Non-Traumatic penile diagnoses
Penile trauma types
Evaluation
- Typically a clinical diagnosis
Management
- Reduction
- Perform as soon as possible
- Consider penile block, local anesthetic cream (EMLA) or procedural sedation
- Use bag of ice (3min intervals) or manual compression before attempting reduction
- Consider granulated sugar (as an osmotic agent)
- Wrap glans with 2x2-in. elastic bandage for 5min
- Use thumbs to push the glans into the foreskin while index fingers pull foreskin back into normal position
- If fails obtain emergent urology consult and/or perform the following:
- Use 22-25ga needle to make multiple punctures (3-5mm deep) in foreskin (expresses glans edema fluid) and then perform compression
- Inject hyaluronidase into the swollen foreskin to decrease edema
- Can also use several evenly spaced, babcock (noncrushing) clamps around foreskin, followed by gentle traction to pull phimotic ring over the glans
- Dorsal Slit indicated if evidence of impaired perfusion and urologist unavailable
Disposition
- Refer all cases to urology to determine need for circumcision
See Also
References
- ↑ https://www.aafp.org/afp/2000/1215/p2623.html
- ↑ Choe, J. (2000). Paraphimosis: Current treatment options. American Family Physician, 62(12):2623-2626.
- ↑ Choe, J. (2000). Paraphimosis: Current treatment options. American Family Physician, 62(12):2623-2626.
- ↑ Choe, J. (2000). Paraphimosis: Current treatment options. American Family Physician, 62(12):2623-2626.
- ↑ Choe, J. (2000). Paraphimosis: Current treatment options. American Family Physician, 62(12):2623-2626.