Paraphimosis: Difference between revisions

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[[File:Paraphimosis.jpg|200px|thumb|right|Paraphimosis in a young adult.]]

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>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>[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>Berk DA, Lee R. [http://www.aafp.org/afp/20040215/letters.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~~>[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~~>

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. [http://www.aafp.org/afp/20040215/letters.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 ==

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== 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>Berk ~~DA, Lee R. [http://www.aafp.org/afp/20040215/letters.html Paraphimosis in a middle-aged adult after intercourse]. ''Am Fam Physician'' 2004;69(4):807.<~~/~~ref~~> The foreskin can then be brought forward to its normal position. Application of ice may also be helpful.<~~ref>[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~~>

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.<refname="NOCIRCpretract"/>

== Hospital treatment ==

There is a number of hospital treatment options available. Injection of hyaluronidase has been shown to be successful.<ref>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>[~~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>Berk ~~DA, Lee R. [http:~~/~~/www.aafp.org/afp/20040215/letters.html Paraphimosis in a middle-aged adult after intercourse]. ''Am Fam Physician'' 2004;69(4):807.</ref~~> 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>Berk ~~DA, Lee R. [http:~~/~~/www.aafp.org/afp/20040215/letters.html Paraphimosis in a middle-aged adult after intercourse]. ''Am Fam Physician'' 2004;69(4):807.</ref~~>

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" />

Reynard and Barua recommend the puncture technique.<ref>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>Berk ~~DA, Lee R. [http://www.aafp.org/afp/20040215~~/~~letters.html Paraphimosis in a middle-aged adult after intercourse]. ''Am Fam Physician'' 2004;69(4):807.</ref~~>

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>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.

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== 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>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~~> The foreskin should be returned to the forward position after cleaning or sexual intercourse.<ref>Choe JM. [http://www.aafp.org/afp/20001215/2623.html Paraphimosis: current treatment options]. ''Am Fam Physician'' 2000;62:2623-2628.</ref><ref>Berk ~~DA, Lee R. [http://www.aafp.org~~/~~afp/20040215/letters.html Paraphimosis in a middle-aged adult after intercourse]. ''Am Fam Physician'' 2004;69(4):807.</ref~~>

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"/>

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.

@@ Line 1: / Line 1: @@
 [[File:Paraphimosis.jpg|200px|thumb|right|Paraphimosis in a young adult.]]
-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>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>[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>Berk DA, Lee R. [http://www.aafp.org/afp/20040215/letters.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>[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>
+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. [http://www.aafp.org/afp/20040215/letters.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 ==
@@ Line 9: / Line 9: @@
 == 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>Berk DA, Lee R. [http://www.aafp.org/afp/20040215/letters.html Paraphimosis in a middle-aged adult after intercourse]. ''Am Fam Physician'' 2004;69(4):807.</ref> The foreskin can then be brought forward to its normal position. Application of ice may also be helpful.<ref>[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>
+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.<refname="NOCIRCpretract"/>
 == Hospital treatment ==
-There is a number of hospital treatment options available. Injection of hyaluronidase has been shown to be successful.<ref>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>[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>Berk DA, Lee R. [http://www.aafp.org/afp/20040215/letters.html Paraphimosis in a middle-aged adult after intercourse]. ''Am Fam Physician'' 2004;69(4):807.</ref> 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>Berk DA, Lee R. [http://www.aafp.org/afp/20040215/letters.html Paraphimosis in a middle-aged adult after intercourse]. ''Am Fam Physician'' 2004;69(4):807.</ref>
+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" />
-Reynard and Barua recommend the puncture technique.<ref>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>Berk DA, Lee R. [http://www.aafp.org/afp/20040215/letters.html Paraphimosis in a middle-aged adult after intercourse]. ''Am Fam Physician'' 2004;69(4):807.</ref>
+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>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.
@@ Line 23: / Line 23: @@
 == 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>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> The foreskin should be returned to the forward position after cleaning or sexual intercourse.<ref>Choe JM. [http://www.aafp.org/afp/20001215/2623.html Paraphimosis: current treatment options]. ''Am Fam Physician'' 2000;62:2623-2628.</ref><ref>Berk DA, Lee R. [http://www.aafp.org/afp/20040215/letters.html Paraphimosis in a middle-aged adult after intercourse]. ''Am Fam Physician'' 2004;69(4):807.</ref>
+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"/>
 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.