PARAPHIMOSIS

Paraphimosis occurs most commonly in children. Diagnose it by recognizing a retracted, swollen and painful foreskin. The glans penis is visible, and is surrounded by an oedematous ring with a proximal constricting ring (Figure 9.35).

Differential diagnosis includes:

Figure 9.35
::	Inflammation of the foreskin (balanitis) due, for example, to infection
::	Swelling caused by an insect bite.

In such cases, the glans is not visible.

Treat paraphimosis by reduction of the foreskin or, if this fails, by dorsal slit or circumcision.

Reduction of the foreskin

1	Sedate the child and prepare the skin of the genitalia with a bland antiseptic. Isolate the penis with a perforated towel and inject local anaesthetic in a ring around its base (Figure 9.36).
Figure 9.36
2	Once local anaesthesia is achieved, take hold of the oedematous part of the penis in the fist of one hand and squeeze firmly; a gauze swab may be necessary for a firm grip (Figure 9.37). Exert continuous pressure, changing hands if necessary, until the oedema fluid passes proximally under the constricting band to the shaft of the penis (Figure 9.38). The foreskin can usually then be pulled over the glans (Figure 9.39).
Figure 9.37
Figure 9.38
Figure 9.39

Aftercare

Have the patient wear a scrotal support for 48 hours after the operation.

::	Phimosis and paraphimosis are definitively treated with circumcision, but can be treated with a dorsal slit of the foreskin
::	Dorsal slit can be performed with direct infiltration of the foreskin with xylocaine 1% without epinephrine (adrenaline)
::	Clamp the foreskin with two artery forceps and make an incision between them (Figure 9.40).
Figure 9.40