Phimosis and Paraphimosis In the ED Medication

Updated: Oct 06, 2022
  • Author: Hina Z Ghory, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Medication Summary

Up to 95% of cases of phimosis have been shown to respond to application of topical steroids to the preputial orifice, [12] although some studies have suggested that this response rate may decline several months after the regimen is completed. [13] An initial attempt at medical intervention has been shown to reduce costs by 27.3% in comparison to primary circumcision as a treatment of phimosis in infants and children. [35] Complications of medication use are limited to preputial pain and hyperemia.

The ED physician may choose to recommend 0.05% betamethasone dipropionate applied to the preputial orifice twice a day for 4-6 weeks. [13]

Betamethasone valerate 0.1%, 0.2%, and 0.2% in combination with hyaluronidase has also been shown to be effective. In one study, patients who initially had partial or no response to this regimen reached complete response after 60 days of treatment. [14]

Anand and Kapoor reported on the use of the osmotic diuretic mannitol to reduce paraphimosis. The procedure required no anesthesia and was associated with minimal or no patient discomfort, according to the authors. They compared it to multiple needle punctures and other nonosmotic methods of reducing paraphimosis. A complete reduction of paraphimosis occurred after mannitol-soaked gauze had been placed over the edematous prepuce for about 30-45 minutes in 6 patients. [15]