Paraphimosis

Steven C. Campbell, M.D., Ph.D.

Paraphimosis is a medical condition where the foreskin becomes trapped behind the glans penis, and cannot be pulled back to its normal flaccid position covering the glans penis. If the condition persists for several hours or there is any sign of a lack of blood flow, paraphimosis should be treated as a medical emergency, as it can result in gangrene or other serious complications.

Paraphimosis occurs most often in children and the elderly.

Paraphimosis can often be reduced by manipulation. This involves compression of the glans, then movement of the foreskin to its normal position, perhaps with the aid of a lubricant. If this fails, the foreskin may need to be cut (dorsal slit procedure) or removed by circumcision. An alternate method, the Dundee technique, entails placing multiple punctures in the swollen foreskin with a fine needle, and then expressing the edema fluid by manual pressure.

Prevention of recurrence is through education of the patient and his care givers on the need to pull back the foreskin over the glans after it has been retracted (for example, when cleaning the glans or passing a foley catheter), or through elective circumcision or preputioplasty.

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Steven C. Campbell, M.D., Ph.D.

Causes of paraphimosis include:

• Direct trauma to the area
• Failure to return the foreskin to its normal location after urination or washing (most common in hospitals and nursing homes)
• Infection, which may be due to poor personal hygiene
• Uncircumcised males, and those who may not have been correctly or completely circumcised, are at risk.

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Steven C. Campbell, M.D., Ph.D.

Paraphimosis occurs most often in children and the elderly.

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Steven C. Campbell, M.D., Ph.D.

If paraphimosis is left untreated, it can disrupt blood flow to the tip of the penis. In extreme (and rare) cases, this may lead to:

• Damage to the penis tip
• Gangrene
• Loss of the penis tip

The outcome is likely to be excellent if the condition is diagnosed and treated quickly.

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