|
Paraphimosis
is a condition occasionally seen in children and young
adults. In many children this is usually due to
curiosity and at times due to insect bite of the
foreskin. Adults usually give a history of sexual
intercourse prior to the occurrence of paraphimosis.
Paraphimosis
is due to a tight prepuce (foreskin of the penis) that
gets retracted forcibly and forms a constrictive band
in the area of the proximal glans penis near the
coronal sulcus. If the prepuce cannot be withdrawn up
to the sulcus, the partial phimosis retracts forming a
tight band around glans penis. Very soon edema in and
around this ring of the prepuce as well as edema of
the glans penis develops. The longer the constriction
continues the more swelling can take place and can
occasionally lead to necrosis of the glans penis.
Because
of this, paraphimosis has to be treated as an
emergency which will also relieve the discomfort, pain
and embarrassment to the patient.
Reduction of
Paraphimosis :
The
objective is to reduce the edema in and around the
constricting band of the foreskin and reposition the
foreskin back to normal.
Requirements:
- A pair of
sterile gloves
- Size 25
hypodermic needle
- Gauze sponge
- Betadine in
saline solution
- 15 blade
knife
- 1% xylocaine
in a 5 cc sterile syringe
This
procedure does not require any general anesthesia and
most often could be accomplished at the bed side after
reassurance and judicial use of 1/2% or 1% novocaine
when necessary.
Procedure:
Patient
in supine position,
-
Area of the genitalia and groin prepared well with
Betadine in saline solution
-
Sterile drapes laid
-
Holding the shaft of the penis firmly with one hand
and using the thumb and index finger of the other hand
the glans penis is gently pushed in gradually
squeezing the edematous fluid to spread out.
- As
the foreskin is advanced forwards and the glans penis
pushed backwards, reduction is obtained.
Many
times this reduction could be further facilitated if
the edematous fluid could be relieved by puncturing
the swollen area of the foreskin with a 25 needle.
This makes the procedure easier when needed and a good
majority of cases can be managed by this way.
Dorsal
Slit Procedure :
Sometimes
the constriction of the prepuce is so tight and the
swelling significant that it would require a small bed
side procedure to relieve a paraphimosis. This is
called the dorsal slit procedure.
After
cleaning the genitalia with Betadine in saline
solution, the selected area at the dorsal side of the
penis close to the constricting band is infiltrated
for about 1 cm width with 1% xylocaine solution.
At this site, a longitudinal incision is made
with 15 blade knife, deliberately dividing the
constriction band. Once the incision is made bloody
edematous fluid will ooze out and this can be sponged.
Following the dorsal slit the foreskin swelling
promptly comes down and becomes easy to fully reduce
the paraphimosis. A total reduction of paraphimosis
has to be accomplished to obtain satisfactory results.
At the end of the procedure one will notice that the
incision that was made is now on the tip of the
foreskin which has been reduced fully. Appropriate
saline dressings are given for a few hours and patient
can return to full normal activity.
- Reduction of
paraphimosis has to be accomplished as an
emergency under sterile precautions.
- Dorsal slit
procedure has to be done to effect full reduction
of the para- phimosis, if simple manual reduction
fails.
- Every patient with
paraphimosis, undergone reduction, should be
advised elective circumcision a few weeks later.
DFH-CP-
Top |
