A dorsal slit of the prepuce or foreskin is performed primarily
in the Emergency Department. This technique is used to relieve strangulation
of the glans by a paraphimosis, to release a paraphimosis, or to
aid in the visualization of the urethral meatus in patients with
a phimosis.1 This technique is easy to learn, simple to
perform, and takes approximately 10 minutes. Performing a dorsal
slit of the foreskin requires complete anesthesia of the foreskin
and/or penis (Chapter 125).
The prepuce, or foreskin, is the skin originating just proximal
to the corona that encircles the glans and often extends beyond
it.2 It may be incomplete, primarily at the ventral midline
or the frenulum. The frenulum is the fusion site of the preputial
and urethral folds. The glans is composed of the corpus spongiosum
that enlarges to cover the tips of the corpora cavernosa. It has
less erectile tissue than the cavernosa and contains the urethra.2
The blood supply to the foreskin and glans is from the left and
right superficial penile arteries. The arteries are derived from
the inferior external pudendal arteries, which are branches of the femoral
arteries. The penile arteries travel in the superficial fascia of
the penis and above Buck’s fascia.3 The left and
right superficial penile arteries freely communicate over the midline.4 Superficial
veins accompany the arteries and ultimately drain to the saphenous
veins in the thighs. The lymphatics travel deep to Buck’s
fascia and ultimately empty into the inguinal chain of lymph nodes.
The somatic nerves to the foreskin are derived from the pudendal
A more detailed description of the anatomy and pathophysiology
of the penis, a paraphimosis, and a phimosis can be found in Chapters 127 and 128.
A dorsal slit of the foreskin should be performed to release
a paraphimosis or a phimosis. A paraphimosis is the inability to
replace the retracted foreskin over the glans. A paraphimosis is
considered an emergency since prolonged retraction of the foreskin
leads to swelling of the prepuce resulting in strangulation injury
to the glans.1 A phimosis is the inability of the foreskin
to retract and expose the glans. A phimosis should be released if
it causes urinary retention. A phimosis can be due to true circumferential
scar formation. Forceable retraction of a phimotic foreskin will
result in tearing of the foreskin. A phimosis may be due to other
disease processes such as edema (secondary to congestive heart failure,
anasarca), inflammation with or without balanitis, or a malignancy.
Refer to Chapters 127 and 128 for further details regarding a paraphimosis
or a phimosis.
There are no absolute contraindications to the reduction of a
paraphimosis. Surgical reductions in children should be performed
by a Pediatric Urologist, a Urologist, or after consultation with
a Urologist. A surgical reduction of a
paraphimosis should be performed only after noninvasive and lesser invasive
techniques have ...