PARAPHIMOSIS
Paraphimosis is a condition where the foreskin becomes trapped behind the glans penis, and cannot be reduced (that is, 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 of tip of penis due to compromise in its blood supply.It is seen in un-cicumcised patients.This is different from phimosis where the fore skin cannot be pulled back.
The foreskin may be retracted during penile examination, penile cleaning, urethral catheterization, or cystoscopy procedures,or at the time of sexual intercourse, sometimes in in local infection,bad local hygiene,etc. The foreskin if left retracted for a long period, causes edema of the foreskin tissue (swollen with fluid),and forms a tight constricting band which makes subsequent reduction of the foreskin difficult.
Paraphimosis can be avoided by bringing the foreskin back into its reduced position after retraction is no longer necessary.If one falls asleep with the fore skin retracted and neglects the area ,it may cause more oedema,change of colour of tip of penis from pink to blue and severe pain by morning especially in phimosis patients.One should not delay even one such episode, as it recurs and causes gangrene.
Phimosis (both pathologic and normal childhood physiologic forms) is a risk factor for paraphimosis. 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 excise the foreskin tissue.)
Paraphimosis can often be effectively treated by manual manipulation of the swollen foreskin tissue. You can most of the times bring the fore skin back yourself.It is like getting a tight ring off your finger with the help of lubricants.This involves compressing the glans and moving the foreskin back to its normal position, usually with the aid of a lubricant, or cold compressions. If this fails, the tight edematous band of tissue can be relieved surgically with a dorsal slit or circumcision.
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. Sometimes,hyaluronidase injection into edematous prepuce is effective in reducing edema and allowing foreskin to be easily reduced.I
According to Ghory and Sharma, treatment by circumcision may be definitive to be performed by a urologist. Other experts recommend delaying elective circumcision until after paraphimosis has been resolved.
In children paraphimosis may also present as obstructive voiding symptoms and acute urinary retention. Because of extreme pain, patients need support from anaesthesiologist in the form of local anaesthetic cream,jelly,injection or sedation with local penile block to relieve pain of manipulation or surgery (circumcision).
Paraphimosis is a condition where the foreskin becomes trapped behind the glans penis, and cannot be reduced (that is, 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 of tip of penis due to compromise in its blood supply.It is seen in un-cicumcised patients.This is different from phimosis where the fore skin cannot be pulled back.
The foreskin may be retracted during penile examination, penile cleaning, urethral catheterization, or cystoscopy procedures,or at the time of sexual intercourse, sometimes in in local infection,bad local hygiene,etc. The foreskin if left retracted for a long period, causes edema of the foreskin tissue (swollen with fluid),and forms a tight constricting band which makes subsequent reduction of the foreskin difficult.
Paraphimosis can be avoided by bringing the foreskin back into its reduced position after retraction is no longer necessary.If one falls asleep with the fore skin retracted and neglects the area ,it may cause more oedema,change of colour of tip of penis from pink to blue and severe pain by morning especially in phimosis patients.One should not delay even one such episode, as it recurs and causes gangrene.
Phimosis (both pathologic and normal childhood physiologic forms) is a risk factor for paraphimosis. 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 excise the foreskin tissue.)
Paraphimosis can often be effectively treated by manual manipulation of the swollen foreskin tissue. You can most of the times bring the fore skin back yourself.It is like getting a tight ring off your finger with the help of lubricants.This involves compressing the glans and moving the foreskin back to its normal position, usually with the aid of a lubricant, or cold compressions. If this fails, the tight edematous band of tissue can be relieved surgically with a dorsal slit or circumcision.
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. Sometimes,hyaluronidase injection into edematous prepuce is effective in reducing edema and allowing foreskin to be easily reduced.I
According to Ghory and Sharma, treatment by circumcision may be definitive to be performed by a urologist. Other experts recommend delaying elective circumcision until after paraphimosis has been resolved.
In children paraphimosis may also present as obstructive voiding symptoms and acute urinary retention. Because of extreme pain, patients need support from anaesthesiologist in the form of local anaesthetic cream,jelly,injection or sedation with local penile block to relieve pain of manipulation or surgery (circumcision).
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