From the Guidelines
Parafimosis is a urological emergency that requires immediate attention to prevent complications, and the first line of treatment should be manual reduction with gentle, steady pressure on the glans while simultaneously pulling the foreskin forward, after applying ice packs and a topical anesthetic. The condition occurs when the foreskin of an uncircumcised penis becomes retracted behind the glans and cannot be returned to its normal position, causing painful swelling and potential tissue damage. Before attempting reduction, it is essential to apply ice packs for 5-10 minutes to reduce swelling and use a topical anesthetic like lidocaine 2% gel to decrease pain, as well as a lubricant such as K-Y jelly to facilitate the reduction attempt.
The provided guidelines for the management of lichen sclerosus do not directly address parafimosis, but they do emphasize the importance of proper management of conditions affecting the male genitalia, such as phimosis caused by lichen sclerosus, which may be related to parafimosis in terms of the need for prompt and effective treatment to prevent complications 1. If manual reduction fails, other techniques such as a puncture technique using a 25-gauge needle to drain edema fluid or a surgical dorsal slit procedure may be necessary. After successful reduction, patients should be advised to practice proper hygiene, avoid prolonged retraction of the foreskin, and follow up with a urologist within 1-2 weeks.
Key considerations in the management of parafimosis include:
- Immediate treatment to prevent complications
- Manual reduction as the first line of treatment
- Use of ice packs, topical anesthetics, and lubricants to facilitate reduction
- Potential need for alternative techniques if manual reduction fails
- Importance of follow-up care to prevent recurrence and address any underlying conditions.
From the Research
Definition and Causes of Parafimosis
- Parafimosis occurs when the foreskin of the penis is retracted over the glans and cannot be replaced in its normal position, causing vascular occlusion and potentially leading to necrosis of the glans 2.
- The condition is often iatrogenically induced and can be prevented by returning the prepuce to cover the glans following penile manipulation 3.
Symptoms and Treatment
- Parafimosis is a urologic emergency that can cause pain and, if not treated quickly, can lead to necrosis of the glans 2.
- Treatment often begins with reduction of edema, followed by a variety of options, including mechanical compression, pharmacologic therapy, puncture technique, and dorsal slit 3.
- Simple reduction of the prepuce can be achieved by compressing the edematous fluid out of the glans and repositioning the foreskin, while irreducible paraphimosis is treated by dorsal slit procedure and subsequent circumcision 2.
Prevention and Management
- Prevention and early intervention are key elements in the management of parafimosis 3.
- Returning the prepuce to cover the glans following penile manipulation can help prevent parafimosis 3.
- There is no direct evidence in the provided studies to suggest a link between parafimosis and other medical conditions such as digital necrosis or bronchopulmonary dysplasia 4, 5.