Paraphimosis

Paraphimosis

Paraphimosis is a urological emergency in which the foreskin remains trapped behind the glans penis after retraction, leading to swelling and impaired blood flow.

Causes

• Prolonged retraction of the foreskin after catheterisation, medical examination, or sexual activity.
• Forceful retraction of a tight foreskin.
• Recurrent penile infections such as balanitis or balanoposthitis.
• Poor genital hygiene.
• Penile trauma or inflammation.
• Diabetes mellitus causing recurrent infections and foreskin fibrosis.
• Long-standing phimosis that is suddenly retracted.

Risk Factors

• Uncircumcised males.
• Elderly patients with urinary catheters.
• Patients with diabetes.
• Recurrent genital infections.
• Poor foreskin care.

Symptoms

1. Painful swelling of the glans penis.
2. Red, bluish, or dark discoloration of the glans.
3. Foreskin stuck behind the glans and not reducible.
4. Tenderness and tightness.
5. Difficulty in passing urine in severe cases.

When to Seek Medical Help

1. Sudden or increasing swelling of the glans penis.
2. Pain after foreskin retraction.
3. Change in colour of the glans.
4. Inability to pull the foreskin back to its normal position.
5. Difficulty or inability to pass urine.

Why It Is Serious

The tight foreskin causes venous congestion followed by arterial compromise.
Delayed treatment can lead to ischaemia, tissue necrosis, infection, and rarely gangrene.

Diagnosis

Clinical diagnosis based on physical examination.

No routine investigations required.

Treatment Options

Immediate Conservative Management

1. Adequate pain control with local or regional anaesthesia if required.
2. Manual compression of the glans to reduce oedema.
3. Manual reduction of the foreskin after swelling decreases.
4. Cold compresses in early and mild cases.
5. Osmotic methods using medical-grade hyperosmolar agents.

Edema Reduction Techniques

1. Puncture technique using fine needles to drain edema fluid.
2. Intralesional hyaluronidase injection to aid edema reduction.

Surgical Management

1. Dorsal slit of the foreskin when conservative methods fail or constriction is severe.
2. Emergency surgical release if blood flow is compromised.

Definitive Treatment

1. Circumcision to prevent recurrence and correct underlying foreskin pathology.
2. Laser circumcision as an alternative with minimal bleeding and faster recovery where available.

Aftercare and Recovery

1. Swelling and pain usually reduce within a few days.
2. Good local hygiene and wound care are essential.
3. Antibiotics or anti-inflammatory medicines if infection or inflammation is present.
4. Return to routine activities within two to five days depending on treatment.
5. Sexual activity should be avoided until complete healing.

Prevention

• Maintain proper genital hygiene.
• Early treatment of penile infections.
• Careful catheter handling.
• Definitive surgical treatment in recurrent cases.