Paraphimosis is a condition occasionally seen in children and young adults. In many children this is usually due to curiosity and at times due to insect bite of the foreskin. Adults usually give a history of sexual intercourse prior to the occurrence of paraphimosis.

Paraphimosis is due to a tight prepuce (foreskin of the penis) that gets retracted forcibly and forms a constrictive band in the area of the proximal glans penis near the coronal sulcus. If the prepuce cannot be withdrawn up to the sulcus, the partial phimosis retracts forming a tight band around glans penis. Very soon edema in and around this ring of the prepuce as well as edema of the glans penis develops. The longer the constriction continues the more swelling can take place and can occasionally lead to necrosis of the glans penis.
Because of this, paraphimosis has to be treated as an emergency which will also relieve the discomfort, pain and embarrassment to the patient.

• A pair of sterile gloves

• Size 25 hypodermic needle

• Gauze sponge

• Betadine in saline solution

• 15 blade knife

• 1% xylocaine in a 5 cc sterile syringe
  This procedure does not require any general anesthesia and most often could be accomplished at the bed side after reassurance and judicial use of 1/2% or 1% novocaine when necessary.

Procedure:
Patient in supine position,
- area of the genitalia and groin prepared well with Betadine in saline solution
- sterile drapes laid
- Holding the shaft of the penis firmly with one hand and using the thumb and index finger of the other hand the glans penis is gently pushed in gradually squeezing the edematous fluid to spread out.
- As the foreskin is advanced forwards and the glans penis pushed backwards, reduction is obtained.
Many times this reduction could be further facilitated if the edematous fluid could be relieved by puncturing the swollen area of the foreskin with a 25 needle. This makes the procedure easier when needed and a good majority of cases can be managed by this way.

Dorsal Slit Procedure :
Sometimes the constriction of the prepuce is so tight and the swelling significant that it would require a small bed side procedure to relieve a paraphimosis. This is called the dorsal slit procedure.

After cleaning the genitalia with Betadine in saline solution, the selected area at the dorsal side of the penis close to the constricting band is infiltrated for about 1 cm width with 1% xylocaine solution. At this site, a longitudinal incision is made with 15 blade knife, deliberately dividing the constriction band. Once the incision is made bloody edematous fluid will ooze out and this can be sponged. Following the dorsal slit the foreskin swelling promptly comes down and becomes easy to fully reduce the paraphimosis. A total reduction of paraphimosis has to be accomplished to obtain satisfactory results. At the end of the procedure one will notice that the incision that was made is now on the tip of the foreskin which has been reduced fully. Appropriate saline dressings are given for a few hours and patient can return to full normal activity.

* Reduction of paraphimosis has to be accomplished as an emergency under sterile precautions. * Dorsal slit procedure has to be done to effect full reduction of the para- phimosis, if simple manual reduction fails. * Every patient with paraphimosis, undergone reduction, should be advised elective circumcision a few weeks later.

Comment & Contribute Comments should be on the topic and should not be abusive. Comments are normally moderated and are reviewed after they are posted. Post your comments * Your comment can be maximum of 2500 characters I agree to the terms and conditions Your comments are automatically posted once they are submitted. All comments are however constantly reviewed for spam and irrelevant material (such as product or personal advertisements, email addresses, telephone numbers and website address). Such insertions do not conform to our policy and 'Terms of Use' and are either deleted or edited and republished. Please keep your comments brief and relevant.This section may also have questions seeking help. If you have the information you are welcome to respond, but please ensure that the information so provided is genuine and not misleading. If you have a question about health related issues, you can now post it in our Ask An Expert section on our community website Medwonders.com and get answers from our panel of experts. Member Comments ( 8 ) what can i do as a nurse when the female urethral meatus during cathetherization is invisible. posted by shadrack kipkorir , from kenya (Posted by shadrack, Canada Date : 10/13/2010 ) what are the problems associated with catheterization (Posted by Rubenson, Ghana Date : 9/26/2010 ) I have undergone dorsal slit operation 20 days ago,now the swollen in completely cured however the cut on the foreskin has not healed till now, pls suggest how long will it take to completely heal so that i can go for regular intercourse.RAHUL. (Posted by RAHUL79, India Date : 8/26/2010 ) I would like ask about this. I have pain in left mandibular if I open my mouth so I just open my mouth not normal. This condition has happened for 2 weeks. what should I do? thank you..:0 (Posted by worries, Thailand Date : 8/4/2010 ) My daughter has very specific needs including a daily Female Catheter. She had gotten an infection in the hospital and I was worried about caring for her from home. We use 180medical.com for all her supplies. The people there are very professional and knowledgeable. They helped me to get exactly what I needed for my daughter including peace of mind for me. (Posted by sstevens76, United States Date : 6/20/2010 ) View All Comments (8)