Paraphimosis

Section: Urology Curriculum: Curriculum, page 28

Definition

• Forcible retraction of the foreskin which can not be replaced

Aetiology

• Typically in the context of Phimosis and retraction with subsequent intrapment
  • Iatrogenic → IDC placement or penis piercing

Pathophysiology

• Prolonged retraction can lead to venous and lymphatic congestion
• Becomes a constriction like band
• Subsequent arterial occlusion to the glans which can results in penile ischaemia

Clinical

• Painful and swollen glans penis in a patient that is un or partially circumcised
• Hx of trauma or IDC

Management

• Ice/compression and attempt at manual reduction
• Penile block and Dorsal slit

Elective circumcision

• Circumcision Indications
  • Phimosis and paraphimosis
  • Balanitis
  • Lichen sclerosus
  • UTI/prostatitis
  • Genital warts
  • Foreskin malignant lesions or penile cancer
  • Prevention of STI and HIV transmission
• Techniques (sleeve)
  • Penile nerve block - base of penis dorsal, 1 and 11 oclock, deep to bucks fascia, insert needle to pubic bone then pull back a bit
  • Mark the base of glans with foreskin retracted and out
  • Make circumferential incisions with foreskin out
  • Join the 2 incisions with a longitudinal incision on the dorsal aspect
  • Diathermy foreskin away
  • Pull skin up shaft and suture with interrupted 4.0 vicryl
• Contraindications
  • Prematurity
  • Penile anomalies - chordee
  • Hypospadia/epispadia
  • Concealed/buried/micropenis
  • Webbed penis
  • Ambiguous genitalia
• Circumcisions Complications
  • Early
    • Bleeding, infection, wound dehiscence
    • Under or over excision (tethering/shortening)
  • Later
    • Glans hyperaesthesia, meatal stenosis, buried penis

Natural Hx

• Ischaemia and necrosis of the glands if not rectified quickly