Paraphimosis

Paraphimosis is a relatively uncommon condition and occurs less often than phimosis.

Paraphimosis is almost always an iatrogenically or inadvertently induced condition. The condition occurs more often in hospitals and nursing homes than in the private community. In the private community, either the affected individual or a parent often retracts the prepuce and then inadvertently leaves it in its retracted position. In most cases, the foreskin reduces on its own and therefore precludes paraphimosis; however, if the slightest resistance to retraction of the prepuce is present, leaving it in this state predisposes it to paraphimosis. As edema accumulates, the condition worsens.

Paraphimosis is an uncommon condition in which the foreskin, once pulled back behind the glans penis, cannot be brought down to its original position, thus constituting one of the few urologic emergencies encountered in general practice. Like phimosis, paraphimosis occurs only in uncircumcised or partly circumcised males.

Paraphimosis is different from phimosis, a nonemergency condition in which the foreskin cannot be pulled back behind the glans penis.

Patients with mild forms of paraphimosis have excellent outcomes, but severe paraphimosis can lead to dire consequences; therefore, view paraphimosis as a urologic emergency.

Paraphimosis may occur when the foreskin has been pulled back behind the head of the penis for an extended period and is often caused by well-meaning health professionals secondary to penile examination or urethral instrumentation.

When paraphimosis is suspected, immediately obtain a urology consult for proper evaluation and diagnosis. Prompt attention and treatment of this emergency should lead to a favorable outcome.

A more unusual cause of paraphimosis is self-infliction, such as piercing with a penile ring into the glans.

Because paraphimosis is a condition that is almost always iatrogenically or inadvertently induced, simple education and clarification of proper prepuce care to parents, the individuals themselves, and health care professionals may be all that is required to prevent this problem.


http://emedicine.medscape.com/article/442883-overview


In foreskin educated Countries, Phimosis and Paraphimosis are extremely rare

The Finnish National Board of Health provided national case records for the year 1970 for both phimosis and paraphimosis. A total of 409 cases was reported for males 15 years and older,which represents only 2/100ths of 1% (0.023%) of the total male population in that age group. This means that 99.97% did NOT develop a problem. Moreover, according to Finnish authorities, only a fraction of the reported cases required surgery-- a number too small to reliably estimate.

Wallerstein, Edward, CIRCUMCISION: AN AMERICAN HEALTH FALLACY p.128


Paraphimosis: Conservative Treatment


First aid for this condition is simple. The head of the penis must be squeezed very tightly between thumb and forefinger. This forces blood out of the head and reduces the size.6 The foreskin can then be brought forward to its normal position.

Application of ice may also be helpful.3 Hospital treatment with injection of hyaluronidase has been shown to be successful.1,3,6 Hyaluronidase works by reducing the oedema, after which the foreskin may be returned to its normal position. When the foreskin has been returned to its normal position, no further treatment is necessary.6 Some doctors recommend circumcision but there is no evidence in the medical literature to support this recommendation.

Library holdings

  1. DeVries CR, Miller AK, Packer MG. Reduction of paraphimosis with hyaluronidase. Urology 1996 48(3):464-465
  2. Reynard JM, Barua JM. Reduction of paraphimosis the simple way - the Dundee technique. BJU Int 1999;83(7):859-860.
  3. Answers to Your Questions About Premature (Forcible) Retraction of Your Son's Foreskin. San Anselmo: NOCIRC, 2000.
  4. Choe JM. Paraphimosis: current treatment options. Am Fam Physician 2000;62:2623-2628.
  5. Turner CD, Kim HL, Cromie WJ. Dorsal band traction for deduction of paraphimosis. Urology 1999;54:917-8.
  6. Berk DA, Lee R. Paraphimosis in a middle-aged adult after intercourse. Am Fam Physician 2004;69(4):807.