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PARAPHIMOSIS
Category: Urology
Abstract : Paraphimosis Definition and presentation This is where the foreskin is
retracted from over the glans of the penis, becomes oedematous, and cannot then
be pulled back over the glans into its normal anatomical position. It occurs
most commonly in teenagers or young men and also in elderly men (who have had
the foreskin retracted during catheterization, but where it has not been
retur
Paraphimosis
Definition and presentation
This is where the foreskin is
retracted from over the glans of the penis, becomes oedematous, and cannot then
be pulled back over the glans into its normal anatomical position. It occurs
most commonly in teenagers or young men and also in elderly men (who have had
the foreskin retracted during catheterization, but where it has not been
returned to its normal position).
Paraphimosis is usually painful. The foreskin
is oedematous and a small area of ulceration of the foreskin may have
developed.
Treatment
The iced-glove method: apply topical
lignocaine gel to the glans and foreskin for 5 min. Place ice and water in a
rubber glove and tie a knot in the cuff of the glove to prevent the contents
from pouring out. Invaginate the penis into the thumb of the glove. This may
reduce the swelling and allow reduction of the foreskin.
Granulated sugar
placed in a condom or glove and applied over the end of the penis has been used
to reduce the oedema by osmosis.
The Dundee technique: give the patient a
broad spectrum antibiotic such as 500mg of ciprofloxacin by mouth. Apply a ring
block to the base of the penis using a 26G needle and 10 20ml of 0.5% plain
bupivicaine (children usually require general anaesthesia). Clean the skin of
the foreskin and the glans with cleaning solution. Using a 25G needle make
approximately 20 punctures into the oedematous foreskin. Squeeze the oedema
fluid out of the foreskin and return to its normal position. Approximately one
third of patients subsequently require elective circumcision for an underlying
phimosis.
If this fails, the traditional surgical treatment is a dorsal
slit under general anaesthetic or ring block. A longitudinal incision is made in
the tight band of constricting tissue and the foreskin pulled back over the
glans. Close the incision transversely to lengthen the circumference of the
foreskin and prevent recurrences.
Hit: 399 times
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