How to treat paraphimosis?

Treatment of Paraphimosis

The most effective approach to treating paraphimosis is manual reduction after decompressing the edematous glans, with surgical intervention reserved for cases where manual reduction fails. 1

Manual Reduction Techniques

• Apply gentle, sustained pressure to the edematous glans to reduce swelling while simultaneously attempting to pull the foreskin forward over the glans 1, 2
• Multiple small punctures with an 18-gauge needle can be made in the edematous foreskin followed by gentle manual compression to allow drainage of edematous fluid, facilitating reduction 3
• Using a flexible self-adhering bandage (such as CoFlex®) can help compress the edematous tissue and assist with reduction 2

Step-by-Step Approach

1. First attempt: Manual reduction

   • Compress the glans penis with gentle pressure for 5-10 minutes to reduce edema 1
   • Apply ice packs to help decrease swelling 3
   • Once swelling is reduced, attempt to pull the foreskin forward over the glans 1

2. If initial manual reduction fails: Consider osmotic methods

   • Apply granulated sugar or mannitol to the edematous tissue to draw out fluid through osmosis 4
   • After reduction in swelling, attempt manual reduction again 4

3. If still unsuccessful: Needle puncture technique

   • Use an 18-gauge needle to make multiple small punctures in the edematous prepuce 3
   • Apply gentle compression to express edematous fluid 3
   • Reattempt manual reduction 3

4. Last resort: Surgical intervention

   • If all conservative measures fail, a dorsal slit procedure should be performed 5
   • This is typically followed by a formal circumcision at a later date 5

Special Considerations

• Paraphimosis is a urologic emergency that can lead to tissue necrosis and gangrene if left untreated 2
• In patients with phimosis as an underlying cause, consider treatment with topical steroids after resolution of the acute paraphimosis to prevent recurrence 6
• For adult males with recurrent episodes, circumcision may be recommended as a definitive treatment 5

Common Pitfalls

• Delaying treatment can lead to worsening edema, making reduction more difficult and increasing risk of tissue necrosis 1
• Excessive force during manual reduction attempts can cause additional trauma 4
• Failure to identify and treat underlying causes (such as lichen sclerosus) may lead to recurrence 6

Prevention of Recurrence

• Patient education on proper retraction and replacement of foreskin is essential 5
• For patients with underlying phimosis, consider topical steroid therapy (clobetasol propionate 0.05% ointment once daily for 1-3 months) 6
• In cases of recurrent paraphimosis or when associated with lichen sclerosus, elective circumcision may be indicated 6, 5