What is the treatment for a new paraphimosis (inflammation of the glans penis) following urinary catheterization (insertion of a catheter into the urinary bladder) in a pediatric patient (child)?

From the Guidelines

To treat paraphimosis in a child following catheterization, first attempt manual reduction by applying gentle, sustained pressure on the glans penis while simultaneously pulling the foreskin forward, as this approach is crucial in preventing ischemia and necrosis of the glans. When managing paraphimosis, it is essential to prioritize prompt treatment to avoid complications such as vascular compromise and necrosis.

• Before attempting reduction, apply a topical anesthetic gel and use ice packs for 5-10 minutes to reduce swelling, as this can facilitate a less painful and more successful procedure 1.
• If manual reduction fails after 10-15 minutes of gentle pressure, seek immediate urological consultation as surgical intervention may be necessary.
• During the reduction attempt, use adequate lubrication with sterile water-soluble lubricant and ensure the child is comfortable, possibly with appropriate pain medication or sedation depending on the severity.
• Paraphimosis is a urological emergency that requires prompt treatment to prevent ischemia and necrosis of the glans, and the condition occurs when the foreskin becomes trapped behind the glans and cannot be returned to its normal position, causing progressive swelling and vascular compromise.
• After successful reduction, monitor for recurrence and educate caregivers about proper foreskin care, including gentle retraction during bathing and ensuring the foreskin is returned to its normal position after cleaning or catheterization, as preventive measures are key in avoiding future episodes of paraphimosis. Key considerations in the management of paraphimosis include the potential for complications such as infection, and the importance of proper wound care and follow-up to prevent such outcomes 1.

From the Research

Treatment Options for Paraphimosis

• Manual reduction methods can be used to treat paraphimosis, often following reduction of edema 2
• Osmotic methods, puncture and aspiration methods, and treatments using sharp incision are also available options for resolving paraphimosis 3
• A technique sequence for treatment is suggested, which may include the use of penile block local anaesthesia 3
• A novel approach to paraphimosis reduction utilizes CoFlex(®), a flexible self-adhering bandage, as a conservative management option 4

Reduction Techniques

• Application of ice packs, compressive elastic bandages, and making a dorsal slit are techniques described to reduce oedema distal to the constricting ring 5
• A "puncture" technique can be used to treat paraphimosis, involving an 18 gauge hypodermic needle to puncture the oedematous foreskin at multiple sites, followed by gentle manual compression 5
• Mechanical compression and pharmacologic therapy are also options for reducing edema and treating paraphimosis 2

Prevention and Management

• Prevention and early intervention are key elements in the management of paraphimosis, which can be prevented by returning the prepuce to cover the glans following penile manipulation 2
• Paraphimosis is a urologic emergency that requires prompt reduction to prevent possible necrosis of the glans or urinary obstruction 5, 2, 4