• 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.