eMedicine Specialties > Clinical Procedures > Genitourinary Procedures

Paraphimosis Reduction

Author: Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Contributor Information and Disclosures

Updated: Jan 5, 2010

Introduction

Paraphimosis is the inability to reduce a swollen and proximally positioned foreskin over the glans penis (see images below).1,2,3 Paraphimosis is most often iatrogenic, occurring when medical personnel forget to reduce the foreskin after instrumentation or catheterization of the urethra.1,4 The foreskin does not become fully mobile before the age of 3-4 years, predisposing children younger than 3-4 years to paraphimosis when their caregivers retract the foreskin for cleaning.

Paraphimosis.

Paraphimosis.

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Paraphimosis.

Paraphimosis.


Constricting (phimotic) ring.

Constricting (phimotic) ring.

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Constricting (phimotic) ring.

Constricting (phimotic) ring.


The retracted foreskin initially blocks lymphatic drainage from the distal penis, progressively causing further edema of the retracted foreskin. If the foreskin remains retracted and the edema continuous, venous obstruction followed by arterial flow are expected within hours to days.5

For more information on paraphimosis and the related condition phimosis, see eMedicine article Phimosis and Paraphimosis.

Indications

  • All patients with paraphimosis require emergent reduction.

Contraindications

  • Nonsurgical techniques are contraindicated in patients who have the following conditions:
    • Necrotic or ulcerated foreskin
    • Necrotic or ulcerated penis
  • Surgical techniques should be performed by or after consultation with a urologist.6

More on Paraphimosis Reduction

Overview: Paraphimosis Reduction
Treatment & Medication: Paraphimosis Reduction
Multimedia: Paraphimosis Reduction
References
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References

  1. Choe JM. Paraphimosis: current treatment options. Am Fam Physician. Dec 15 2000;62(12):2623-6, 2628. [Medline].

  2. Williams JC, Morrison PM, Richardson JR. Paraphimosis in elderly men. Am J Emerg Med. May 1995;13(3):351-3. [Medline].

  3. Rangarajan M, Jayakar SM. Paraphimosis revisited: is chronic paraphimosis a predominantly third world condition?. Trop Doct. Jan 2008;38(1):40-2. [Medline].

  4. Paynter M. Paraphimosis. Emerg Nurse. Jul 2006;14(4):18-9. [Medline].

  5. Lawless MR. The foreskin. Pediatr Rev. Dec 2006;27(12):477-8. [Medline].

  6. Borsellino A, Spagnoli A, Vallasciani S, Martini L, Ferro F. Surgical approach to concealed penis: technical refinements and outcome. Urology. Jun 2007;69(6):1195-8. [Medline].

  7. Mackway-Jones K, Teece S. Best evidence topic reports. Ice, pins, or sugar to reduce paraphimosis. Emerg Med J. Jan 2004;21(1):77-8. [Medline].

  8. Dawson C, Whitfield H. ABC of Urology. Urological emergencies in general practice. BMJ. Mar 30 1996;312(7034):838-40. [Medline].

  9. Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE. Trends in paediatric circumcision and its complications in England between 1997 and 2003. Br J Surg. Jul 2006;93(7):885-90. [Medline].

  10. Little B, White M. Treatment options for paraphimosis. Int J Clin Pract. May 2005;59(5):591-3. [Medline].

  11. Reichman EF, Simon RR. Emergency Medicine Procedures. Columbus, Ohio: McGraw Hill Medical Publishing; 2004.

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Further Reading

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Keywords

paraphimosis, paraphimosis reduction, uncircumcised, uncircumcized, penile anesthesia, penile block, phimotic ring, Babcock clamp technique, needle decompression technique, manual reduction of paraphimosis, swollen foreskin, iced glove technique, reduced foreskin, retracted foreskin, reduction of foreskin

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Contributor Information and Disclosures

Author

Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Luis M Lovato, MD, Associate Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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