From the Guidelines
Paraphimosis with glans outpouching is a medical emergency that requires immediate attention to prevent complications, and the first step is manual reduction of the foreskin after applying a topical anesthetic gel and using manual compression to reduce edema of the glans 1.
Causes and Complications
Paraphimosis occurs when the foreskin becomes trapped behind the glans penis, creating a constricting band that can compromise blood flow. The outpouching may result from fluid accumulation due to venous and lymphatic obstruction caused by the constricting foreskin. Without treatment, this condition can lead to tissue necrosis, so prompt intervention is crucial.
Management
If manual reduction fails, a dorsal slit procedure or emergency circumcision may be necessary. For the outpouching specifically, careful assessment is needed to determine if it represents edema or a structural abnormality. After reduction, apply cold compresses and elevate the penis to reduce swelling. Patients should be prescribed anti-inflammatory medication such as ibuprofen 400-600mg three times daily for 3-5 days to manage inflammation. Proper hygiene with gentle cleansing and avoiding retraction until healing is complete is essential.
Prevention
It is essential to note that paraphimosis can be associated with certain conditions, such as lichen sclerosus, and circumcision may have a role in management, especially in cases where the disease is limited to the glans and foreskin 1. However, the primary concern in cases of paraphimosis with glans outpouching is to address the immediate complication and prevent further tissue damage.
Key Considerations
- Manual reduction of the foreskin is the first line of treatment
- Dorsal slit procedure or emergency circumcision may be necessary if manual reduction fails
- Careful assessment of the outpouching to determine if it represents edema or a structural abnormality
- Application of cold compresses and elevation of the penis to reduce swelling
- Prescription of anti-inflammatory medication to manage inflammation
- Proper hygiene and avoidance of retraction until healing is complete are essential to prevent further complications.
From the Research
Paraphimosis Glans Outpouching
- Paraphimosis is a serious and painful condition that requires prompt reduction to prevent possible necrosis of the glans or urinary obstruction 2.
- The condition occurs when the foreskin becomes trapped behind the corona and forms a tight band of constricting tissue, often iatrogenically induced 3.
- Treatment options for paraphimosis include reduction of edema, mechanical compression, pharmacologic therapy, puncture technique, and dorsal slit 3.
- A simple "puncture" technique has been used to treat paraphimosis, involving puncturing the oedematous foreskin at multiple sites with an 18 gauge hypodermic needle, followed by gentle manual compression 2.
- Prevention and early intervention are key elements in the management of paraphimosis, and returning the prepuce to cover the glans following penile manipulation can help prevent the condition 3.
Relevant Studies
- A study published in the European journal of pediatric surgery in 1994 described a case of paraphimosis in an uncircumcised 12-year-old boy, which was successfully treated using the puncture technique 2.
- A review article published in the American family physician in 2000 discussed current treatment options for paraphimosis, including mechanical compression, pharmacologic therapy, puncture technique, and dorsal slit 3.
- Note that the study published in the International journal of molecular sciences in 2022 is not relevant to paraphimosis glans outpouching, as it discusses the role of sphingolipid signaling in oxidative lung injury and the pathogenesis of bronchopulmonary dysplasia 4.