Paraphimosis and complicated phimosis

Definition

• Phimosis: inability to retract the foreskin to expose the glans.
• Paraphimosis: inability to return the retracted foreskin over the glans—an emergency that threatens glans ischemia.

Clinical assessment

• Paraphimosis: constriction of the glans, edema, cyanosis, pain.
• Phimosis: inability to expose the glans, recurrent balanitis, difficulty voiding.

Emergency management of paraphimosis

1. Analgesia (local anesthesia, with sedation if needed).
2. Compression of the glans (manually, using the fingers) to reduce edema.
3. Reduction (by pressing on the glans and drawing the foreskin forward).
4. If unsuccessful, perform a dorsal slit of the constricting ring under local anesthesia.
5. After reduction: anti-inflammatory medication, cold application, observation.
6. Elective circumcision at a later stage.

Algorithm