From the Guidelines
Paraphimosis treatment should prioritize immediate manual reduction with local anesthesia and edema reduction to prevent complications, and if unsuccessful, a dorsal slit procedure or emergency circumcision may be necessary. The treatment of paraphimosis involves a step-by-step approach to reduce the risk of complications such as ischemia and necrosis of the glans penis. According to the provided evidence, paraphimosis has been associated with urethral and glans piercings in uncircumcised men 1.
Initial Management
The first step in treating paraphimosis is manual reduction, which involves applying gentle pressure on the glans penis while simultaneously pulling the foreskin forward. Before attempting reduction, pain management with local anesthesia (such as lidocaine gel 2%) and edema reduction using osmotic agents like granulated sugar or 50% dextrose solution applied to the swollen foreskin for 5-10 minutes can improve success rates.
Alternative Methods
If manual reduction fails, a dorsal slit procedure or emergency circumcision may be necessary. The foreskin may be reduced manually after a penile nerve block, and if this maneuver is unsuccessful, the prepuce can be injected with hyaluronidase to allow the edematous fluid to dissipate, as mentioned in the context of penile piercings 1.
Post-Reduction Care
After successful reduction, patients should be instructed on proper hygiene and complete retraction during cleaning to prevent recurrence. Cold compresses can help reduce residual swelling. It is essential to recognize paraphimosis as a urological emergency because prolonged constriction can lead to ischemia and necrosis of the glans. Patients with recurrent episodes should consider elective circumcision. Any signs of tissue damage or inability to urinate require immediate medical attention.
Key Considerations
- Manual reduction with local anesthesia and edema reduction
- Dorsal slit procedure or emergency circumcision if manual reduction fails
- Proper hygiene and complete retraction during cleaning to prevent recurrence
- Recognition of paraphimosis as a urological emergency
- Consideration of elective circumcision for recurrent episodes
- Immediate medical attention for signs of tissue damage or inability to urinate.
From the Research
Treatment Options for Paraphimosis
- Manual reduction methods are available for treating paraphimosis, as outlined in a review of treatment options 2
- Osmotic methods, puncture and aspiration methods, and treatments using sharp incision are also described in the literature 2
- The technique of penile block local anaesthesia is described, and a technique sequence for treatment is suggested 2
Reducing Edema in Paraphimosis
- Application of ice packs, compressive elastic bandages, and making a dorsal slit are techniques used to reduce edema distal to the constricting ring 3
- A "puncture" technique using an 18 gauge hypodermic needle to puncture the oedematous foreskin at multiple sites, followed by gentle manual compression, has been used to treat paraphimosis successfully 3
- Reduction of edema is often the first step in treatment, followed by various options such as mechanical compression, pharmacologic therapy, puncture technique, and dorsal slit 4
Comparison of Treatment Methods
- A short cut review compared the ice glove technique, the multiple puncture technique, and the application of sugar for paraphimosis reduction, and found that three papers presented the best evidence to answer the clinical question 5
- The review established which approach was the best for paraphimosis reduction, although the specific results are not detailed in the study abstract
Note on Irrelevant Study
- One study 6 is not relevant to the treatment of paraphimosis, as it discusses the role of sphingolipid signaling in oxidative lung injury and the pathogenesis of bronchopulmonary dysplasia.