Paraphimosis

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Paraphimosis
Classification and external resources
Paraphimosis.jpg
Paraphimosis
ICD-10N47.2
ICD-9605
DiseasesDB9613
MedlinePlus001281
 
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Paraphimosis
Classification and external resources
Paraphimosis.jpg
Paraphimosis
ICD-10N47.2
ICD-9605
DiseasesDB9613
MedlinePlus001281

Paraphimosis (/ˌpærəfˈmsəs/ or /ˌpærəfəˈmsəs/[1][2]) is an uncommon[3] medical condition where the foreskin becomes trapped behind the glans penis, and cannot be reduced (pulled back to its normal flaccid position covering the glans penis). If this condition persists for several hours or there is any sign of a lack of blood flow, paraphimosis should be treated as a medical emergency, as it can result in gangrene.[3][4][5]

Causes[edit]

Paraphimosis is usually caused by well-meaning medical professionals or parents who handle the foreskin improperly:[3][5] The foreskin may be retracted during penile examination, penile cleaning, urethral catheterization, or cystoscopy; if the foreskin is left retracted for a long period, some of the foreskin tissue may become edematous (swollen with fluid), which makes subsequent reduction of the foreskin difficult.

Prevention and treatment[edit]

Paraphimosis can be avoided by bringing the foreskin back into its reduced position after retraction is no longer necessary (for instance, after cleaning the glans penis or placing a Foley catheter). Phimosis (both pathologic and normal childhood physiologic forms) is a risk factor for paraphimosis;[4] physiologic phimosis resolves naturally as a child matures, but it may be advisable to treat pathologic phimosis via long-term stretching or elective surgical techniques (such as preputioplasty to loosen the pruptial orifice or circumcision to amputate the foreskin tissue partially or completely).[citation needed]

Paraphimosis can often be effectively treated by manual manipulation of the swollen foreskin tissue. This involves compressing the glans and moving the foreskin back to its normal position, perhaps with the aid of a lubricant, cold compression, and local anesthesia as necessary. If this fails, the tight edematous band of tissue can be relieved surgically with a dorsal slit[3][5] or circumcision.[6][7][8][9][10] An alternative method, the Dundee technique, entails placing multiple punctures in the swollen foreskin with a fine needle, and then expressing the edema fluid by manual pressure.[7] According to Ghory and Sharma, treatment by circumcision may be elected as "a last resort, to be performed by a urologist".[11] Other experts recommend delaying elective circumcision until after paraphimosis has been resolved.[3][5]

See also[edit]

References[edit]

  1. ^ OED 2nd edition, 1989 as /ˌpærəfaɪˈməʊsɪs/.
  2. ^ Entry "paraphimosis" in Merriam-Webster Online Dictionary.
  3. ^ a b c d e Jeffrey M Donohoe; Jason O Burnette; James A Brown (October 7, 2009). "Paraphimosis". eMedicine. "Patients with severe paraphimosis that proves refractory to conservative therapy will require a bedside emergency dorsal slit procedure to save the penis. A formal circumcision can be performed in the operating room at a later date... At a later date, a formal circumcision can be performed as an outpatient procedure." 
  4. ^ a b Hina Z Ghory; Rahul Sharma (April 28, 2010). "Phimosis and Paraphimosis". eMedicine. "Patients with phimosis, both physiologic and pathologic, are at risk for developing paraphimosis when the foreskin is forcibly retracted past the glans and/or the patient or caretaker forgets to replace the foreskin after retraction." 
  5. ^ a b c d Choe JM (2000). "Paraphimosis: Current Treatment Options". American Family Physician 62 (12): 2623–6, 2628. PMID 11142469. "If a severely constricting band of tissue precludes all forms of conservative or minimally invasive therapy, an emergency dorsal slit should be performed. This procedure should be performed with the use of a local anesthetic by a physician experienced with the technique... Circumcision, a definitive therapy, should be performed at a later date to prevent recurrent episodes, regardless of the method of reduction used." 
  6. ^ Richard A Santucci; Ryan P Terlecki (April 15, 2009). "Phimosis, Adult Circumcision, and Buried Penis". eMedicine. "Reduction of the foreskin under sedation is almost always possible. However, in some situations, a dorsal slit or circumcision is required" 
  7. ^ a b Reynard JM, Barua JM. Reduction of paraphimosis the simple way - the Dundee technique. BJU Int. 1999;83(7):859-60. doi:10.1046/j.1464-410x.1999.00119.x. PMID 10368214.
  8. ^ Surgical care at the district hospital. World Health Organization. 2003. pp. 9–10. ISBN 92-4-154575-5. 
  9. ^ Latha Ganti Stead, S. Matthew Stead, and Matthew S. Kaufman (2006). First Aid for the Emergency Medicine Clerkship. p. 231. ISBN 0-07-144873-X. 
  10. ^ Stephen Zderic, Natalie Platcher, and Jennifer Kirk (2008). Pediatric Urology for the Primary Care Provider. p. 80. ISBN 1-55642-785-9. 
  11. ^ Hina Z Ghory; Rahul Sharma (April 28, 2010). "Phimosis and Paraphimosis". eMedicine.