Paraphimosis is the entrapment of a retracted foreskin that cannot be reduced behind the coronal sulcus. Pain, swelling, and erythema are common. If severe, the constriction causes edema and venous engorgement of the glans, which can lead to arterial compromise with subsequent tissue necrosis. In contrast to paraphimosis, phimosis is the inability to retract the foreskin, which can be physiologic in children.
Management and Disposition
First liberally apply granulated sugar to the glans and foreskin (prepuce). After 15 to 20 minutes, the osmotic effect will help decrease edema and ease reduction. Next squeeze the glans firmly for 5 minutes to reduce the swelling and then reduce the glans into the foreskin by pushing the glans inward with the thumbs while the index fingers pull the prepuce over the coronal sulcus. If manual reduction fails, consult a urologist for local infiltration of anesthesia with vertical incision of the constricting band.
Reduction of the edema with firm, constant pressure is generally effective.
Do not forcibly retract the foreskin in patients with phimosis.
Paraphimosis. Moderate edema of retracted foreskin, which is entrapped behind the coronal sulcus. (Photo contributor: Lawrence B. Stack, MD.)
Paraphimosis. Edema of retracted foreskin entrapped behind the coronal sulcus. (Photo contributor: David Effron, MD.)
Phimosis. Phimosis in a young patient is physiologic, but also may have obstruction from meatal stenosis and scarring. (Photo contributor: Alan B. Storrow, MD.)
Phimosis. Phimosis that required catheterization to relieve obstruction. (Photo contributor: David Effron, MD.)