eMedicine Specialties > Clinical Procedures > Genitourinary Procedures

Dorsal Slit of the Foreskin

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
Coauthor(s): Eric W Snyder, MD, MS, Chief Resident, Deparment of Emergency Medicine, University of California at Los Angeles/Olive View-UCLA Medical Center
Contributor Information and Disclosures

Updated: Mar 29, 2009

Introduction

Dorsal slit of the foreskin is performed to relieve strangulation of the glans by a paraphimosis or to visualize the urethral meatus in patients with phimosis.1,2

Indications

  • Phimosis: Phimosis is the inability of the foreskin to retract and expose the glans.3 Dorsal slit of the foreskin should only be performed on patients who are experiencing urinary retention as a result of the phimosis and in whom a urethral catheter cannot be blindly inserted.4

    Phimotic foreskin. The distal foreskin is edemato...

    Phimotic foreskin. The distal foreskin is edematous, with cracked fissures. The patient was unable to retract the foreskin.

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    Phimotic foreskin. The distal foreskin is edemato...

    Phimotic foreskin. The distal foreskin is edematous, with cracked fissures. The patient was unable to retract the foreskin.

  • Paraphimosis: Paraphimosis is the inability to replace the retracted foreskin.5,6 Dorsal slit of the foreskin should only be performed on patients whose paraphimosis could not be reduced with manual techniques.7

    Paraphimosis.

    Paraphimosis.

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    Paraphimosis.

    Paraphimosis.

Contraindications

  • No absolute contraindications exist to the performance of dorsal slit of the foreskin.
  • Dorsal slit of the foreskin should be performed only after failure of noninvasive techniques. For detailed descriptions of manual reduction techniques for paraphimosis, please see eMedicine article Paraphimosis Reduction.
  • Pediatric patients, patients with bleeding disorders, and patients who are immunocompromised or have an infected foreskin are better treated by (or after consultation with) a urologist.8,9

More on Dorsal Slit of the Foreskin

Overview: Dorsal Slit of the Foreskin
Treatment & Medication: Dorsal Slit of the Foreskin
Multimedia: Dorsal Slit of the Foreskin
References
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References

  1. Stine RJ, Avila JA, Lemons MF, Sickorez GJ. Diagnostic and therapeutic urologic procedures. Emerg Med Clin North Am. Aug 1988;6(3):547-78. [Medline].

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

  3. McGregor TB, Pike JG, Leonard MP. Pathologic and physiologic phimosis: approach to the phimotic foreskin. Can Fam Physician. Mar 2007;53(3):445-8. [Medline].

  4. Thiruchelvam N, Nayak P, Mostafid H. Emergency dorsal slit for balanitis with retention. J R Soc Med. Apr 2004;97(4):205-6. [Medline].

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

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

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

  8. 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].

  9. Chu CC, Chen YH, Diau GY, Loh IW, Chen KC. Preputial flaps to correct buried penis. Pediatr Surg Int. Nov 2007;23(11):1119-21. [Medline].

  10. Holman JR, Stuessi KA. Adult Circumcision. American Family Physician [serial online]. March 15, 1999;59(6):1514-8. Available from: http://www.aafp.org. [Medline]. Available at http://www.aafp.org/afp/990315ap/1514.html.

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

  12. Reichman E, Simon R. Dorsal slit of the foreskin. In: Emergency Medicine Procedures. New York, NY: McGraw-Hill; 2004.

  13. Roberts JR, Hedges JR. Urologic procedures. In: Chanmugam AS, Chudnofsky CR, Custalow CB, Dronen SC, eds. Roberts: Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, Pa: WB Saunders; 2004:1075-6.

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Further Reading

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Keywords

dorsal slit, dorsal slit of foreskin, phimosis, paraphimosis, circumcision, adult circumcision, foreskin, foreskin reduction, phimosis reduction, paraphimosis reduction, glans, anesthesia of foreskin, anesthesia of penis, foreskin anesthesia, penis anesthesia, phimotic, paraphimotic, foreskin incision, dorsal incision

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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.

Coauthor(s)

Eric W Snyder, MD, MS, Chief Resident, Deparment of Emergency Medicine, University of California at Los Angeles/Olive View-UCLA Medical Center
Eric W Snyder, MD, MS is a member of the following medical societies: Alpha Omega Alpha
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: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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