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 pressure and lubrication, followed by emergency medical care if necessary. The condition is characterized by the foreskin becoming trapped behind the glans penis and unable to return to its normal position, which can lead to tissue necrosis and gangrene if left untreated.
Key Considerations
- The British Association of Dermatologists guidelines for the management of lichen sclerosus 1 provide valuable insights into the treatment of related conditions, but parafimosis is a distinct emergency that requires prompt action.
- Manual reduction should be attempted first, using techniques such as applying gentle, steady pressure on the glans while pulling the foreskin forward, and using lubricants like lidocaine gel and ice packs to reduce swelling 1.
- If manual reduction fails, emergency medical care is necessary, where healthcare providers may use osmotic methods, puncture techniques, or surgical intervention like a dorsal slit or circumcision.
Prevention and Management
- Prevention involves proper hygiene, complete retraction and replacement of the foreskin during cleaning, and avoiding leaving the foreskin retracted for extended periods.
- The guidelines for lichen sclerosus 1 emphasize the importance of referral to a specialist urologist for conditions like phimosis and urethral stricture, but in the case of parafimosis, immediate action is necessary to prevent complications.
- The use of topical treatments like clobetasol propionate 0.05% ointment 1 may be relevant for conditions like lichen sclerosus, but it is not a primary treatment for parafimosis.
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 Options
- Parafimosis is a urologic emergency that can cause serious penile injury, including gangrene and tissue necrosis, if left unattended for a period of time 4.
- Treatment options include reduction of edema, mechanical compression, pharmacologic therapy, puncture technique, and dorsal slit procedure 3.
- A novel approach to paraphimosis reduction utilizes a flexible self-adhering bandage, such as CoFlex(®) 4.
Potential Complications
- If not dealt with quickly, parafimosis can lead to necrosis of the glans 2.
- Irreducible paraphimosis is treated by dorsal slit procedure and subsequent circumcision 2.
- Parafimosis can be prevented by returning the prepuce to cover the glans following penile manipulation, and early intervention is key in managing the condition 3.