Paraphimosis Reduction

imagesParaphimosis (foreskin trapped proximal to coronal sulcus) is a urologic emergency, and reduction is always indicated when the condition is present


CONTRAINDICATIONS



imagesNone


RISKS/CONSENT ISSUES



imagesPain (local anesthesia will be given)


imagesLocal bleeding


imagesInfection (sterile technique will be used)


imagesScarring at site of incision/dilation (though definitive treatment will likely include circumcision, removing the scarred tissue)


imagesDamage to glans penis and urethral meatus



imagesGeneral Basic Steps


If manual reduction fails to restore normal anatomy, proceed to assisted manual reduction; if that fails as well, proceed to phimotic ring incision. A urologist should be contacted if manual reduction fails, and will need to be actively involved if emergency circumcision is required because of reduction failure.


   imagesPatient preparation


   imagesAnesthesia


   imagesManual reduction


   imagesAssisted manual reduction (FIGURE 37.1)


   imagesPhimotic ring incision


TECHNIQUE



imagesPatient Preparation


   imagesPosition: Supine with legs slightly abducted


   imagesConsider light procedural sedation as well


imagesAnesthesia


   imagesA topical anesthetic may be all that is necessary


      imagesApply viscous lidocaine or eutectic mixture of local anesthetics (EMLA) to the inner layer of the foreskin


      imagesAlso serves as a lubricant


   imagesIf further anesthesia is necessary, progress from local, to dorsal nerve block, and, finally, to penile ring block


      imagesSee chapter 36 for details and pictures of penile anesthesia


      imagesWhen providing local anesthesia with lidocaine (without epinephrine), be sure to infiltrate into the constricting ring as well


imagesManual Reduction


   imagesUsing your hands or an elastic bandage, manually compress the glans and foreskin for 3 to 5 minutes to remove as much edema as possible


   imagesPlace both thumbs on the glans penis and apply slow, steady pressure while using your other fingers just proximal to the phimotic ring to pull the foreskin over the glans penis (FIGURE 37.2)


   imagesSuccessful reduction occurs when the phimotic foreskin is reduced back to normal position over the glans


   imagesIf unsuccessful, proceed to assisted manual reduction methods



images


FIGURE 37.1 Technique for compression of glans to reduce edema and allow for manual reduction of paraphimosis. (From Green M, Strange GR. Paraphimosis reduction. In: Henretig FM, King C, eds. Textbook of Pediatric Emergency Procedures. Philadelphia, PA: Williams & Wilkins; 1997:1008, with permission.)

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Paraphimosis Reduction

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