Common Bed Side Procedures

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Reduction of Para Phimosis and Dorsal Slit Procedure
Common Bed Side Procedure No. 4
Section Editor: Prof. T.K. Partha Sarathy

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 If the prepuce cannot be withdrawn up to the sulcus, the partial phimosis retracts forming a tight band around glans penis.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.


Reduction of Paraphimosis :
The objective is to reduce the edema in and around the constricting band of the foreskin and reposition the foreskin back to normal.

Requirements:
  • 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.

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man23 

I'm a 23 year old male,it was only today that I came to know about my paraphimosis. It happened because of my own mistakes,at that time I my foreskin was swollen badly,there was pain. But I didn't tell parents or consulted a doctor because I was ashamed of myself. I know it was a wrong choice. However after 15 days pain was gone,and everything was normal except that my foreskin wont come back on its usual place,and it was stuck behind the glan forming oedema. It's been 6 years, I can do all the normal thing. But my oedema is still there. I want to know if it can cause any problem in future?

shadrack 

what can i do as a nurse when the female urethral meatus during cathetherization is invisible.
posted by shadrack kipkorir , from kenya

Rubenson 

what are the problems associated with catheterization

RAHUL79 

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.

worries 

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

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