Difference between revisions of "Paraphimosis"

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[[File:Paraphimosis.jpg|200px|thumb|right|Paraphimosis in a young adult.]]
 
[[File:Paraphimosis.jpg|200px|thumb|right|Paraphimosis in a young adult.]]
  
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Paraphimosis is a condition where a [[retraction of the foreskin|retracted]] [[foreskin]] becomes trapped behind the head of the penis, and thus unable to return to its forward position covering the glans. If the condition is prolonged, paraphimosis can become an emergency.<ref name="DeVries">DeVries CR, Miller AK, Packer MG. [http://www.cirp.org/library/treatment/phimosis/devries/ Reduction of paraphimosis with hyaluronidase]. ''Urology'' 1996 48(3):464-465</ref> <ref name="NOCIRCpretract">[http://www.nocirc.org/publish/6pam.pdf ''Answers to Your Questions About Premature (Forcible) Retraction of Your Son's Foreskin'']. San Anselmo: NOCIRC, 2000.</ref> <ref name="Berk">Berk DA, Lee R. [https://www.aafp.org/afp/2004/0215/p807.html| Paraphimosis in a middle-aged adult after intercourse]. ''Am Fam Physician'' 2004;69(4):807.</ref> The tissue may become oedematous and swell thus further aggravating the problem.<ref name="NOCIRCpretract"/>
+
Paraphimosis is a condition where a [[retraction of the foreskin|retracted]] [[foreskin]] becomes trapped behind the head of the [[penis]], and thus unable to return to its forward position covering the [[glans]]. If the condition is prolonged, paraphimosis can become an emergency.<ref name="DeVries">DeVries CR, Miller AK, Packer MG. [http://www.cirp.org/library/treatment/phimosis/devries/ Reduction of paraphimosis with hyaluronidase]. ''Urology'' 1996 48(3):464-465</ref> <ref name="NOCIRCpretract">[http://www.nocirc.org/publish/6pam.pdf ''Answers to Your Questions About Premature (Forcible) Retraction of Your Son's Foreskin'']. San Anselmo: NOCIRC, 2000.</ref> <ref name="Berk">Berk DA, Lee R. [https://www.aafp.org/afp/2004/0215/p807.html Paraphimosis in a middle-aged adult after intercourse]. ''Am Fam Physician'' 2004;69(4):807.</ref> The tissue may become oedematous and swell thus further aggravating the problem.<ref name="NOCIRCpretract"/>
  
 
== Cause ==
 
== Cause ==
 +
===Childhood===
 +
Paraphimosis is a perfectly avoidable, [[iatrogenic]] condition. In infants and young children, this condition may occur as a result of doctors, parents or caretakers [[forced retraction|forcibly retracting]] the [[foreskin]] of a child's penis. It may also occur in older males as a result of [[Forced foreskin retraction| forcible retraction of a foreskin]] whose orifice has not yet dilated enough to allow the [[glans penis|glans]] through. (See [[phimosis]].) The first person to retract a boy's foreskin should be the boy himself.<ref name="wright1994">{{REFjournal
 +
|last=Wright
 +
|init=JE
 +
|author-link=
 +
|etal=no
 +
|title=Further to the <q>Further Fate of the Foreskin</q>
 +
|journal=Med J Aust
 +
|location=
 +
|date=1994-02-07
 +
|volume=160
 +
|issue=3
 +
|pages=134-5
 +
|url=http://www.cirp.org/library/normal/wright2/
 +
|quote=
 +
|pubmedID=8295581
 +
|pubmedCID=
 +
|DOI=
 +
|accessdate=2021-06-02
 +
}}</ref>
 +
===Adulthood===
 +
Paraphimosis may result when a tight or phimotic [[foreskin]] is forcibly retracted. Paraphimosis may also result from sexual intercourse with a tight foreskin.
  
−
Paraphimosis is a perfectly avoidable, iatrogenic condition. In infants and young children, this condition may occur as a result of doctors, parents or caretakers [[forced retraction|forcibly retracting]] the [[foreskin]] of a child's penis. It may also occur in older males as a result of [[Forced foreskin retraction| forcible retraction of a foreskin]] whose orifice has not yet dilated enough to allow the [[glans penis|glans]] through. (See [[phimosis]].)
+
== First aid ==
  
−
== First aid ==
+
First aid for this condition is simple. The head of the [[penis]] must be squeezed very tightly between thumb and forefinger. This forces blood out of the head and reduces the size.<ref name="Berk"/> The [[foreskin]] can then be brought forward to its normal position. Application of ice may also be helpful.<ref name="NOCIRCpretract"/>
  
−
First aid for this condition is simple. The head of the penis must be squeezed very tightly between thumb and forefinger. This forces blood out of the head and reduces the size.<ref name="Berk"/> The foreskin can then be brought forward to its normal position. Application of ice may also be helpful.<ref name="NOCIRCpretract"/>
+
See the Video section for additional methods of reducing paraphimosis.
  
 
== Hospital treatment ==
 
== Hospital treatment ==
  
−
There is a number of hospital treatment options available. Injection of hyaluronidase has been shown to be successful.<ref name="DeVries"/><ref name="NOCIRCpretract"/>[<ref name="Berk" /> Hyaluronidase works by reducing the oedema, after which the foreskin may be returned to its normal position. When the foreskin has been returned to its normal position, no further treatment is necessary.<ref name="Berk" />  
+
There are a number of hospital treatment options available. Injection of hyaluronidase has been shown to be successful.<ref name="DeVries"/><ref name="NOCIRCpretract"/>[<ref name="Berk" /> Hyaluronidase works by reducing the oedema, after which the foreskin may be returned to its normal position. When the foreskin has been returned to its normal position, no further treatment is necessary.<ref name="Berk" />  
  
 
Reynard and Barua recommend the puncture technique.<ref name="Reynard">Reynard JM, Barua JM. [http://www.cirp.org/library/treatment/phimosis/reynard1/ Reduction of paraphimosis the simple way - the Dundee technique]. ''BJU'' Int 1999;83(7):859-860.</ref> Incisions are not necessary. Improved cosmetic outcome is claimed. Again no circumcision is necessary.<ref name="Berk"/>
 
Reynard and Barua recommend the puncture technique.<ref name="Reynard">Reynard JM, Barua JM. [http://www.cirp.org/library/treatment/phimosis/reynard1/ Reduction of paraphimosis the simple way - the Dundee technique]. ''BJU'' Int 1999;83(7):859-860.</ref> Incisions are not necessary. Improved cosmetic outcome is claimed. Again no circumcision is necessary.<ref name="Berk"/>
  
−
Turner ''et al''. recommend using Adson forceps to apply traction to return the prepuce to its normal forward position.<ref name="Turner">Turner CD, Kim HL, Cromie WJ. [http://www.cirp.org/library/treatment/paraphimosis/turner1/ Dorsal band traction for deduction of paraphimosis]. ''Urology'' 1999;54:917-8.</ref>
+
Turner et al. recommend using Adson forceps to apply traction to return the prepuce to its normal forward position.<ref name="Turner">Turner CD, Kim HL, Cromie WJ. [http://www.cirp.org/library/treatment/paraphimosis/turner1/ Dorsal band traction for deduction of paraphimosis]. ''Urology'' 1999;54:917-8.</ref>
  
−
Some doctors recommend circumcision as treatment, but there is no evidence in the medical literature to support this recommendation. Additionally, this radical form of treatment sacrifices the prepuce, where patients may seek to preserve its function and value, and protection of the individual from unnecessarily radical surgery is always a doctor's prerogative.
+
Some doctors recommend [[circumcision]] as treatment, but there is no evidence in the medical literature to support this recommendation. Additionally, this radical form of treatment sacrifices the [[prepuce]], where patients may seek to preserve its function and value, and protection of the individual from unnecessarily radical surgery is always a doctor's prerogative.
  
 
==Video==
 
==Video==
 +
Dr. Pravin H. Shinde demostrates paraphimosis reduction without surgery.
 +
<br><br>
 +
<youtube>A21gDqW5e4E</youtube>
  
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Paraphimosis reduction without surgery.<br>
+
Paraphimosis reduction without surgery.
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<center>
 
 
<youtube>v=xBE8UmREne0</youtube>
 
<youtube>v=xBE8UmREne0</youtube>
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</center>
+
 
 
== Prevention ==
 
== Prevention ==
  
−
Education concerning proper care and development of the prepuce is the most effective way of preventing paraphimosis from occurring. Parents, doctors, and other caretakers should be instructed to never [[forced retraction|forcibly retract]] a boy's foreskin. In older males, the forcible retraction of a narrow foreskin should be avoided.<ref name="Reynard" /> The foreskin should be returned to the forward position after cleaning or sexual intercourse.<ref name="Choe">Choe JM. [http://www.aafp.org/afp/20001215/2623.html Paraphimosis: current treatment options]. ''Am Fam Physician'' 2000;62:2623-2628.</ref> <ref name="Berk"/>
+
Education concerning proper care and development of the prepuce is the most effective way of preventing paraphimosis from occurring. Parents, doctors, and other caretakers should be instructed to never [[forced retraction|forcibly retract]] a boy's foreskin. In older males, the forcible retraction of a narrow [[foreskin]] should be avoided.<ref name="Reynard" /> The [[foresk should be returned to the forward position after cleaning or sexual intercourse.<ref name="Choe">Choe JM. [http://www.aafp.org/afp/20001215/2623.html Paraphimosis: current treatment options]. ''Am Fam Physician'' 2000;62:2623-28.</ref> <ref name="Berk"/>
 +
 
 +
Some doctors recommend [[Adolescent and adult circumcision| circumcision]] as prevention, but there is no evidence in the medical literature to support this recommendation. Furthermore, this sacrifices the prepuce, where patients may seek to preserve its [http://www.intactaus.org/information/functionsoftheforeskin/ function] and value, and protection of the individual from unnecessarily radical surgery is always a doctor's prerogative.
  
−
Some doctors recommend circumcision as prevention, but there is no evidence in the medical literature to support this recommendation. Furthermore, this sacrifices the prepuce, where patients may seek to preserve its function and value, and protection of the individual from unnecessarily radical surgery is always a doctor's prerogative.
+
Manual [[stretching]] of the tight tip of the [[foreskin]] to widen the narrow part will prevent recurrence of paraphimosis. [[Stretching]] is not complete until the [[foreskin]] will [[Gliding action|glide smoothly back and forth]] while the [[penis]] is in a state of [[erection]].
  
−
Manual stretching of the tight tip of the [[foreskin]] to widen the narrow part will prevent recurrence of paraphimosis.
+
{{SEEALSO}}
 +
* [[Foreskin]]
 +
* [[Gliding action]]
 +
* [[Penis]]
 +
* [[Phimosis]]
 +
* [[Reduction of paraphimosis]]
 +
* [[Stretching]]
 +
* [[Tissue expansion]]
 +
 
 +
{{LINKS}}
 +
* {{REFjournal
 +
|last=Choe
 +
|first=Jong M
 +
|init=
 +
|author-link=
 +
|etal=no
 +
|title=Paraphimosis: Current Treatment Options
 +
|trans-title=
 +
|language=
 +
|journal=Am Fam Physician.
 +
|location=
 +
|date=2000-12-15
 +
|season=
 +
|volume=62
 +
|issue=12
 +
|article=
 +
|page=
 +
|pages=2623-6, 2628
 +
|url=https://www.aafp.org/pubs/afp/issues/2000/1215/p2623.html
 +
|archived=
 +
|quote=
 +
|pubmedID=11142469
 +
|pubmedCID=
 +
|DOI=
 +
|accessdate=2022-06-08
 +
}}
 +
* {{REFweb
 +
|url=https://www.cirp.org/library/treatment/paraphimosis/
 +
|title=Paraphimosis: Conservative Treatment
 +
|last=Anonymous
 +
|first=
 +
|init=
 +
|publisher=Circumcision Reference Library
 +
|date=2004-04-17
 +
|accessdate=2023-04-20
 +
}}
  
 
{{REF}}
 
{{REF}}
 +
 +
[[Category:Medical condition]]
  
 
[[Category:From IntactWiki]]
 
[[Category:From IntactWiki]]
−
[[Category:Medical conditions]]
 

Latest revision as of 02:52, 26 December 2023

IntactiWikiGraphicWarning.png

Paraphimosis in a young adult.

Paraphimosis is a condition where a retracted foreskin becomes trapped behind the head of the penis, and thus unable to return to its forward position covering the glans. If the condition is prolonged, paraphimosis can become an emergency.[1] [2] [3] The tissue may become oedematous and swell thus further aggravating the problem.[2]

Cause

Childhood

Paraphimosis is a perfectly avoidable, iatrogenic condition. In infants and young children, this condition may occur as a result of doctors, parents or caretakers forcibly retracting the foreskin of a child's penis. It may also occur in older males as a result of forcible retraction of a foreskin whose orifice has not yet dilated enough to allow the glans through. (See phimosis.) The first person to retract a boy's foreskin should be the boy himself.[4]

Adulthood

Paraphimosis may result when a tight or phimotic foreskin is forcibly retracted. Paraphimosis may also result from sexual intercourse with a tight foreskin.

First aid

First aid for this condition is simple. The head of the penis must be squeezed very tightly between thumb and forefinger. This forces blood out of the head and reduces the size.[3] The foreskin can then be brought forward to its normal position. Application of ice may also be helpful.[2]

See the Video section for additional methods of reducing paraphimosis.

Hospital treatment

There are a number of hospital treatment options available. Injection of hyaluronidase has been shown to be successful.[1][2][[3] Hyaluronidase works by reducing the oedema, after which the foreskin may be returned to its normal position. When the foreskin has been returned to its normal position, no further treatment is necessary.[3]

Reynard and Barua recommend the puncture technique.[5] Incisions are not necessary. Improved cosmetic outcome is claimed. Again no circumcision is necessary.[3]

Turner et al. recommend using Adson forceps to apply traction to return the prepuce to its normal forward position.[6]

Some doctors recommend circumcision as treatment, but there is no evidence in the medical literature to support this recommendation. Additionally, this radical form of treatment sacrifices the prepuce, where patients may seek to preserve its function and value, and protection of the individual from unnecessarily radical surgery is always a doctor's prerogative.

Video

Dr. Pravin H. Shinde demostrates paraphimosis reduction without surgery.

Paraphimosis reduction without surgery.

Prevention

Education concerning proper care and development of the prepuce is the most effective way of preventing paraphimosis from occurring. Parents, doctors, and other caretakers should be instructed to never forcibly retract a boy's foreskin. In older males, the forcible retraction of a narrow foreskin should be avoided.[5] The [[foresk should be returned to the forward position after cleaning or sexual intercourse.[7] [3]

Some doctors recommend circumcision as prevention, but there is no evidence in the medical literature to support this recommendation. Furthermore, this sacrifices the prepuce, where patients may seek to preserve its function and value, and protection of the individual from unnecessarily radical surgery is always a doctor's prerogative.

Manual stretching of the tight tip of the foreskin to widen the narrow part will prevent recurrence of paraphimosis. Stretching is not complete until the foreskin will glide smoothly back and forth while the penis is in a state of erection.

See also

External links

References

  1. ↑ a b DeVries CR, Miller AK, Packer MG. Reduction of paraphimosis with hyaluronidase. Urology 1996 48(3):464-465
  2. ↑ a b c d Answers to Your Questions About Premature (Forcible) Retraction of Your Son's Foreskin. San Anselmo: NOCIRC, 2000.
  3. ↑ a b c d e f Berk DA, Lee R. Paraphimosis in a middle-aged adult after intercourse. Am Fam Physician 2004;69(4):807.
  4. ↑ REFjournal Wright JE. Further to the Further Fate of the Foreskin. Med J Aust. 7 February 1994; 160(3): 134-5. PMID. Retrieved 2 June 2021.
  5. ↑ a b Reynard JM, Barua JM. Reduction of paraphimosis the simple way - the Dundee technique. BJU Int 1999;83(7):859-860.
  6. ↑ Turner CD, Kim HL, Cromie WJ. Dorsal band traction for deduction of paraphimosis. Urology 1999;54:917-8.
  7. ↑ Choe JM. Paraphimosis: current treatment options. Am Fam Physician 2000;62:2623-28.
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