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, followed by other interventions like dorsal slit procedure or circumcision if necessary. The condition occurs when the foreskin becomes trapped behind the glans penis and cannot be returned to its normal position, which can lead to tissue necrosis and gangrene if left untreated.
Key Considerations
- Manual reduction should be attempted first by applying firm, gentle pressure on the glans for 5-10 minutes to reduce swelling, then pushing the glans back through the foreskin while pulling the foreskin forward.
- Ice packs and sugar solutions (like 50% dextrose) can help reduce edema before attempting reduction.
- If manual reduction fails, a dorsal slit procedure or circumcision may be necessary under local anesthesia.
- Prevention involves proper foreskin care, including returning the foreskin to its normal position after retraction.
Management of Related Conditions
The provided evidence focuses on the management of lichen sclerosus (LS) and its complications, including phimosis, which can be related to parafimosis in terms of foreskin issues [ 1 ]. For patients with LS, topical treatments and referral to specialists are recommended for various complications, but these guidelines do not directly address parafimosis management.
Clinical Approach
Given the urgency of parafimosis, clinical judgment prioritizes immediate relief of the condition to prevent serious complications, making manual reduction the first line of treatment, followed by other medical or surgical interventions as necessary. The management of related conditions like LS, as outlined in guidelines [ 1 ], emphasizes the importance of specialist referral and appropriate treatment to prevent long-term complications, but in the case of parafimosis, immediate action is crucial.
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, and prevention is key by returning the prepuce to cover the glans following penile manipulation 3.
Symptoms and Complications
- Parafimosis is a painful condition that can lead to serious penile injury, including gangrene and tissue necrosis, if left unattended for a period of time 4.
- If not dealt with quickly, it can cause vascular occlusion, much like a tourniquet, and lead to necrosis of the glans 2.
Treatment Options
- Simple reduction of the prepuce can be achieved by compressing the edematous fluid out of the glans and repositioning the foreskin 2.
- Other treatment options include mechanical compression, pharmacologic therapy, puncture technique, and dorsal slit procedure, followed by circumcision if necessary 3, 5.
- A novel approach to paraphimosis reduction utilizes a flexible self-adhering bandage, such as CoFlex(®) 4.
- In severe cases, a dorsal slit procedure may be necessary, which necessitates later circumcision 5.