Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: |Testicular Torsion |Paraphimosis |Hypospadias |Phimosis |Balanitis (Children)
โ ๏ธ It is crucial to return the foreskin to its normal position after catheterisation or any procedure. ๐จ Paraphimosis is a urological emergency โ failure to relieve the constricting band may cause glans necrosis.
| ๐ Severe Paraphimosis: Urgent Urology Help if Not Quickly Reduced |
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| ๐ Comparison Between Phimosis and Paraphimosis | ||
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| Criteria | Phimosis | Paraphimosis |
| Definition | ๐ซ Inability to retract foreskin over glans | ๐จ Retracted foreskin stuck behind glans, causing constriction |
| Causes | Congenital, poor hygiene, recurrent infections, scarring | Forceful retraction, catheterisation, trauma |
| Clinical Features | Tight foreskin, ballooning during urination, discomfort | Pain, swelling, erythema, venous congestion, ischaemia |
| Complications | Urinary retention, recurrent balanitis, โ risk penile Ca | Glans ischaemia, necrosis, gangrene |
| Management | Topical steroids, gentle stretching, circumcision | Manual/ice/osmotic reduction โ dorsal slit/circumcision if fails |
A 62-year-old man presents with a painful, swollen glans and a tight foreskin retracted behind the corona after catheter care; the constricting phimotic ring has caused venous/lymphatic congestion โ oedema โ risk of ischaemia. Give strong analgesia (consider penile block), then attempt manual reduction: ice/anaesthetic gel, compress oedema (elastic wrap for 5โ10 min, or osmotic agents such as granulated sugar/50% dextrose), then push the glans in while pulling the foreskin forward. If unsuccessful, perform puncture/drainage of oedema with multiple fine-needle stabs or a small dorsal slit (sterile technique) and reduce; involve urology urgently if ischaemia, necrosis, or failed bedside reduction. After reduction, do not re-retract the foreskin; treat precipitating causes (catheter care, balanitis), prescribe analgesia ยฑ antibiotics if infected, and arrange definitive circumcision (esp. with recurrent episodes or lichen sclerosus). Document times (onset, reduction) and provide written safety-netting for recurrence or worsening pain/colour change.