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 or without local anesthesia and edema reduction, followed by consideration of surgical options if manual reduction fails. The condition occurs when the foreskin becomes retracted behind the glans and cannot be returned to its normal position, leading to a constricting band that impedes venous and lymphatic drainage, causing progressive swelling and potentially leading to ischemia and necrosis if left untreated 1.
Key Considerations
- Manual reduction should be attempted first by applying gentle, steady pressure on the glans while pulling the foreskin forward.
- Prior to reduction, pain management with local anesthesia (such as lidocaine gel) 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.
- If manual reduction fails, a dorsal slit procedure or emergency circumcision may be required, and patients with underlying conditions such as lichen sclerosus (LS) may require referral to a specialist urologist for further management, including consideration of topical treatments like clobetasol propionate (CP) 0.05% ointment for LS-related phimosis 1.
- Prevention involves proper hygiene education, ensuring the foreskin is returned to its normal position after retraction during cleaning or catheterization, and considering elective circumcision for recurrent cases.
Management of Underlying Conditions
- For patients with LS, consideration of referral to a specialist urologist is crucial for managing complications such as urethral stricture, and treatment may involve CP introduced into the urethra via a urinary catheter or meatal dilator, depending on stricture length, before proceeding to surgical treatment options 1.
- Patients with LS who have failed to respond to topical steroids and/or circumcision may require referral for a specialist urology opinion on other surgical treatment options 1.
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.
- It is a urologic emergency that can be iatrogenically induced, often in uncircumcised males, and can be prevented by returning the prepuce to cover the glans following penile manipulation 3.
Treatment Options for Parafimosis
- Simple reduction of the prepuce can be achieved by compressing the edematous fluid out of the glans and repositioning the foreskin 2.
- Irreducible paraphimosis is treated by dorsal slit procedure and subsequent circumcision 2.
- Other treatment options include mechanical compression, pharmacologic therapy, and puncture technique 3.
Importance of Early Intervention
- Early recognition and treatment of parafimosis are crucial in minimizing morbidity and preventing complications such as necrosis of the glans 2, 3.
- Prevention and early intervention are key elements in the management of parafimosis, and healthcare professionals should be aware of the risks and treatment options for this condition 3.