Daily Bolus of LR: Phimosis and Paraphimosis

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October 12, 2011 by dailybolusoflr

Phimosis

 

·         Is a condition of the uncircumcised penis

·         Is when  constriction of the foreskin prevents retraction back of the tissue over the glans

·         It can be painful, but the most concerning complication is urinary outlet obstruction

·         Most cases are physiologic and present in children- they usually do not require any intervention

·         Adult onset cases are acquired and are typical as a result of trauma, chronic infections or irritation, or poor hygiene

·         Attempts at gentle retraction can be made, but force should not be used

·         If urinary obstruction is present, urology should be contacted for dilation of the outflow tract or surgical release

·         If patients are able to urinate, topical steroid treatment can be effective at reducing inflammation and good hygiene should be stressed

·         Patients who are able to urinate and have no evidence of infection or ischemia can be discharged

 

 

Paraphimosis

·         Is a condition of the uncircumcised penis

·         Is when proximal foreskin cannot be returned to its typical position covering the glans

·         It is a high risk state for complications related to blood flow

o   Both venous outflow and arterial inflow can be compromised

·         Ice, compression and gentle pressure can help to relieve minor paraphimoses, but more severe obstructions may require invasive procedures

·         Urgent circumcision or the ‘dorsal slit’ procedure can be attempted, but typically are done in conjunction with urology

 

Ref: Rosen’s 7th edition

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