Penile dorsal slit: Difference between revisions
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==Indications== | ==Indications== | ||
# Relieve [[Paraphimosis]] that is strangulating the glans | #Relieve [[Paraphimosis]] that is strangulating the glans | ||
# [[Phimosis]] causing urinary retention | #[[Phimosis]] causing urinary retention | ||
==Contraindications== | ==Contraindications== | ||
# no absolute contraindications | #no absolute contraindications | ||
## consult urologist prior to procedure if there is evidence of overlying infection, patients who are immunocompromised, or in those with coagulation disorder | ##consult urologist prior to procedure if there is evidence of overlying infection, patients who are immunocompromised, or in those with coagulation disorder | ||
==Equipment Needed== | ==Equipment Needed== | ||
# betadine | #betadine | ||
# sterile gloves/drape | #sterile gloves/drape | ||
# local anesthesia | #local anesthesia | ||
# 27 gauge needle | #27 gauge needle | ||
# 3cc syringe | #3cc syringe | ||
# straight hemostats or kelly clamp | #straight hemostats or kelly clamp | ||
# iris scissors | #iris scissors | ||
# vicryl suture (3-0 or 4-0) | #vicryl suture (3-0 or 4-0) | ||
# needle driver | #needle driver | ||
# gauze | #gauze | ||
==Procedure== | ==Procedure== | ||
# prep and drape penis in sterile fashion | #prep and drape penis in sterile fashion | ||
# raise a wheal of anesthesia in the foreskin, just proximal to the glans on the dorsal aspect of the penis (27-gauge needle) | #raise a wheal of anesthesia in the foreskin, just proximal to the glans on the dorsal aspect of the penis (27-gauge needle) | ||
# Extend the injection along the longitudinal axis distally to the tip of the foreskin | #Extend the injection along the longitudinal axis distally to the tip of the foreskin | ||
# After 4 min, check to make certain the anesthesia is effective | #After 4 min, check to make certain the anesthesia is effective | ||
# Slide the hemostats along the space between the foreskin and the glans, and gently open, forming a tract. | #Slide the hemostats along the space between the foreskin and the glans, and gently open, forming a tract. | ||
# Remove the hemostats, then replace with one tip between the foreskin and glans, and one tip outside the foreskin, straddling the region of anesthesia. Make certain the tip of the hemostats is not in the urethral meatus. | #Remove the hemostats, then replace with one tip between the foreskin and glans, and one tip outside the foreskin, straddling the region of anesthesia. Make certain the tip of the hemostats is not in the urethral meatus. | ||
# Close the hemostat over the region of anesthesia and keep clamped for 10 min. | #Close the hemostat over the region of anesthesia and keep clamped for 10 min. | ||
# Remove the hemostat, and cut the serrated clamped tissue with the scissors. | #Remove the hemostat, and cut the serrated clamped tissue with the scissors. | ||
##(If the skin edges continue to ooze, a running stitch using a vicryl suture can be placed on each side) | ##(If the skin edges continue to ooze, a running stitch using a vicryl suture can be placed on each side) | ||
# Retract the foreskin and clean the glans | #Retract the foreskin and clean the glans | ||
##(Place a Foley catheter when indicated) | ##(Place a Foley catheter when indicated) | ||
==Complications== | ==Complications== | ||
# bleeding | #bleeding | ||
# pain | #pain | ||
# infection | #infection | ||
# damage to glans or urethra | #damage to glans or urethra | ||
==See Also== | ==See Also== | ||
Revision as of 01:44, 7 July 2016
Indications
- Relieve Paraphimosis that is strangulating the glans
- Phimosis causing urinary retention
Contraindications
- no absolute contraindications
- consult urologist prior to procedure if there is evidence of overlying infection, patients who are immunocompromised, or in those with coagulation disorder
Equipment Needed
- betadine
- sterile gloves/drape
- local anesthesia
- 27 gauge needle
- 3cc syringe
- straight hemostats or kelly clamp
- iris scissors
- vicryl suture (3-0 or 4-0)
- needle driver
- gauze
Procedure
- prep and drape penis in sterile fashion
- raise a wheal of anesthesia in the foreskin, just proximal to the glans on the dorsal aspect of the penis (27-gauge needle)
- Extend the injection along the longitudinal axis distally to the tip of the foreskin
- After 4 min, check to make certain the anesthesia is effective
- Slide the hemostats along the space between the foreskin and the glans, and gently open, forming a tract.
- Remove the hemostats, then replace with one tip between the foreskin and glans, and one tip outside the foreskin, straddling the region of anesthesia. Make certain the tip of the hemostats is not in the urethral meatus.
- Close the hemostat over the region of anesthesia and keep clamped for 10 min.
- Remove the hemostat, and cut the serrated clamped tissue with the scissors.
- (If the skin edges continue to ooze, a running stitch using a vicryl suture can be placed on each side)
- Retract the foreskin and clean the glans
- (Place a Foley catheter when indicated)
Complications
- bleeding
- pain
- infection
- damage to glans or urethra
See Also
References
Emedicine