Penile dorsal slit
Indications
- Relieve paraphimosis
- After failure of non-invasive reduction
- Emergent urology consult not available
- Phimosis causing urinary retention
Contraindications
- No absolute contraindications
- Should be performed by urologist if consultation is immediately available
- Caution when:
- Evidence of overlying infection
- Patient immune compromised
- Patient has coagulation disorder
Equipment Needed
- Betadine or other antiseptic prep solution
- Sterile gloves and drape
- Local anesthetic
- 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
- Using a 27 gauge needle, raise a wheal of anesthetic in the foreskin
- Just proximal to the glans on the dorsal aspect of the penis
- Extend the injection along the longitudinal axis until entire foreskin is anesthetized
- After 4 min, check effectiveness of anesthetic
- Slide closed hemostat between dorsal penis and foreskin
- Gently open hemostat to create a tract
- Remove hemostat
- Open hemostat and insert bottom prong along previously created tract with top prong above the foreskin
- Carefully ensure that hemostat is not in urethral meatus
- Close hemostat to crush foreskin tissue
- Leave hemostat in place for 10 minutes
- Remove hemostat
- Use iris scissors to cut crushed tissue
- Use vicryl to place a running stitch along cut ends of foreskin if oozing is excessive or persistent
- Clean glans
- Place Foley catheter if needed
Complications
- Bleeding
- Pain
- Infection
- Damage to glans or urethra
See Also
References
Emedicine