Paraphimosis - Revision history

SLuckettG: /* Management */

2019-05-15T20:18:28Z

Management

← Older revision		Revision as of 20:18, 15 May 2019
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	*Reduction		*Reduction
	**Perform as soon as possible		**Perform as soon as possible
	**Consider [[Nerve Block: Penile\|penile block]], local anesthetic cream (EMLA) or procedural sedation		**Consider [[Nerve Block: Penile\|penile block]], local anesthetic cream (EMLA) or procedural sedation
	**Use ~~bag of ice (3min intervals) or manual compression before attempting reduction~~
	***Consider granulated sugar (as an osmotic agent)		===Manual Reduction===
	***Wrap glans with ~~2x2-in. elastic~~ bandage for ~~5min~~		#Wearing gloves, encircle the distal penis and apply circumferential pressure to reduce edema
	**Use thumbs to push ~~the~~ glans ~~into the~~ foreskin while ~~index~~ fingers pull foreskin ~~back into normal position~~		#Maintain pressure for several minutes
	*If fails obtain emergent urology consult and/or perform the following:		#Release pressure and advance foreskin over glans
	**Use 22-25ga needle to ~~make multiple punctures~~ (~~3-5mm deep~~) ~~in foreskin (expresses glans edema fluid) and then perform compression~~		#*Use thumbs to push glans toward foreskin while using fingers to pull foreskin over glans
	**Inject hyaluronidase into the swollen foreskin to decrease edema
	**Can also use several evenly spaced, ~~babcock~~ (~~noncrushing~~) clamps around foreskin~~, followed by~~ gentle traction to pull ~~phimotic~~ ring over the glans		===Compressive Bandage Reduction===
			#Wearing gloves, wrap the distal penis in the distal to proximal direction with compressive bandage
			#Leave bandage for several minutes to allow edema to disperse
			#Remove bandage and advance foreskin over glans
			#*Use thumbs to push glans toward foreskin while using fingers to pull foreskin over glans

			===Adjunctive Therapies===
			*Apply ice packs in 3 minute intervals to reduce edema (monitor carefully for frostbite)
			*Apply granulated sugar to distal penis as an osmotic agent
			*Inject hyaluronidase into the swollen foreskin to decrease edema
			*Apply several evenly-spaced, Babcock (non-crushing) clamps around foreskin
			**Apply gentle traction on clamps to pull foreskin over glans

			===Reduction Failure===
			*If above techniques fail:
			#Obtain emergent urology consult
			#Proceed to Dundee aspiration or dorsal slit procedure if urology is not immediately available

			===Dundee Technique<ref>Reynard, J., and Barua, J. (1999). Reduction of paraphimosis the simple way - The Dundee technique. British Journal of Urology, 83(7):859-860.</ref>===
			#Apply local anesthetic, perform a penile ring block, or sedate patient
			#Prep the foreskin using antiseptic
			#Use a 26 gauge needle to make approximately 20 puncture holes in the foreskin
			#Use gentle manual pressure to express edema fluid from foreskin
			#Advance the foreskin over the glans
			#*Use thumbs to push glans toward foreskin while using fingers to pull foreskin over glans

			===Dorsal Slit Procedure===

	**[[Dorsal Slit (Penis)\|Dorsal Slit]] indicated if evidence of impaired perfusion and urologist unavailable		**[[Dorsal Slit (Penis)\|Dorsal Slit]] indicated if evidence of impaired perfusion and urologist unavailable

SLuckettG: /* Clinical Features */

2019-05-15T19:49:00Z

Clinical Features

← Older revision		Revision as of 19:49, 15 May 2019
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	==Clinical Features==		==Clinical Features==
	[[File:PMC2791735 wjem-10-281f1.png\|thumb\|Paraphimosis with non-retractable foreskin and distal swelling ]]		[[File:PMC2791735 wjem-10-281f1.png\|thumb\|Paraphimosis with non-retractable foreskin and distal swelling ]]
	*~~Pain~~		*Penile pain
	*~~Erythema~~		*Enlarged and erythematous glans<ref>Choe, J. (2000). Paraphimosis: Current treatment options. American Family Physician, 62(12):2623-2626.</ref>
	*~~Swelling distal to constricting ring of foreskin~~		*Constricting band immediately behind glans<ref>Choe, J. (2000). Paraphimosis: Current treatment options. American Family Physician, 62(12):2623-2626.</ref>
			*Penile shaft flaccid<ref>Choe, J. (2000). Paraphimosis: Current treatment options. American Family Physician, 62(12):2623-2626.</ref>
			*Pediatric patients may present with obstructive urinary symptoms<ref>Choe, J. (2000). Paraphimosis: Current treatment options. American Family Physician, 62(12):2623-2626.</ref>

	==Differential Diagnosis==		==Differential Diagnosis==

SLuckettG: /* Background */

2019-05-15T19:45:42Z

Background

← Older revision		Revision as of 19:45, 15 May 2019
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	==Background==		==Background==
	*~~Foreskin~~ trapped behind glans		*Retracted foreskin becomes trapped behind glans
			**Acts as constricting band<ref>https://www.aafp.org/afp/2000/1215/p2623.html</ref>
			**May result in glans necrosis as venous engorgement leads to arterial compromise
	*Urologic emergency		*Urologic emergency
	**May result in glans necrosis if not reduced due to venous engorgement causing arterial compromise

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Clinical Features */

2018-03-14T13:21:48Z

Clinical Features

← Older revision		Revision as of 13:21, 14 March 2018
Line 5:		Line 5:

	==Clinical Features==		==Clinical Features==
			[[File:PMC2791735 wjem-10-281f1.png\|thumb\|Paraphimosis with non-retractable foreskin and distal swelling ]]
	*Pain		*Pain
	*Erythema		*Erythema

Rossdonaldson1: /* Management */

2018-03-14T13:19:50Z

Management

← Older revision		Revision as of 13:19, 14 March 2018
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	**Consider [[Nerve Block: Penile\|penile block]], local anesthetic cream (EMLA) or procedural sedation		**Consider [[Nerve Block: Penile\|penile block]], local anesthetic cream (EMLA) or procedural sedation
	**Use bag of ice (3min intervals) or manual compression before attempting reduction		**Use bag of ice (3min intervals) or manual compression before attempting reduction
	***Consider granulated sugar		***Consider granulated sugar (as an osmotic agent)
	***Wrap glans with 2x2-in. elastic bandage for 5min		***Wrap glans with 2x2-in. elastic bandage for 5min
	**Use thumbs to push the glans into the foreskin while index fingers pull foreskin back into normal position		**Use thumbs to push the glans into the foreskin while index fingers pull foreskin back into normal position

Lisayee25: /* Management */

2018-03-01T19:42:29Z

Management

← Older revision		Revision as of 19:42, 1 March 2018
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	**Consider [[Nerve Block: Penile\|penile block]], local anesthetic cream (EMLA) or procedural sedation		**Consider [[Nerve Block: Penile\|penile block]], local anesthetic cream (EMLA) or procedural sedation
	**Use bag of ice (3min intervals) or manual compression before attempting reduction		**Use bag of ice (3min intervals) or manual compression before attempting reduction
			***Consider granulated sugar
	***Wrap glans with 2x2-in. elastic bandage for 5min		***Wrap glans with 2x2-in. elastic bandage for 5min
	**Use thumbs to push the glans into the foreskin while index fingers pull foreskin back into normal position		**Use thumbs to push the glans into the foreskin while index fingers pull foreskin back into normal position

Rossdonaldson1 at 13:42, 1 February 2017

2017-02-01T13:42:52Z

← Older revision		Revision as of 13:42, 1 February 2017
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	**May result in glans necrosis if not reduced due to venous engorgement causing arterial compromise		**May result in glans necrosis if not reduced due to venous engorgement causing arterial compromise

	==~~Evaluation~~==		==Clinical Features==
	*Pain~~, erythema, swelling~~ distal to constricting ring of foreskin		*Pain
			*Erythema
			*Swelling distal to constricting ring of foreskin

	==Differential Diagnosis==		==Differential Diagnosis==
	{{Nontrauma penile DDX}}		{{Nontrauma penile DDX}}
	{{Penile Trauma DDX}}		{{Penile Trauma DDX}}

			==Evaluation==
			*Typically a clinical diagnosis

	==Management==		==Management==

Rossdonaldson1: /* Differential Diagnosis */

2017-02-01T13:42:02Z

Differential Diagnosis

← Older revision		Revision as of 13:42, 1 February 2017
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Nontrauma penile DDX}}		{{Nontrauma penile DDX}}
			{{Penile Trauma DDX}}

	==Management==		==Management==

Devin Smith at 00:32, 31 January 2017

2017-01-31T00:32:05Z

← Older revision		Revision as of 00:32, 31 January 2017
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	*Reduction		*Reduction
	**Perform as soon as possible		**Perform as soon as possible
	**Consider penile block, local anesthetic cream (EMLA) or procedural sedation		**Consider [[Nerve Block: Penile\|penile block]], local anesthetic cream (EMLA) or procedural sedation
	**Use bag of ice (3min intervals) or manual compression before attempting reduction		**Use bag of ice (3min intervals) or manual compression before attempting reduction
	***Wrap glans with 2x2-in. elastic bandage for 5min		***Wrap glans with 2x2-in. elastic bandage for 5min

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-25T03:59:21Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 03:59, 25 July 2016
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	**May result in glans necrosis if not reduced due to venous engorgement causing arterial compromise		**May result in glans necrosis if not reduced due to venous engorgement causing arterial compromise

	==~~Diagnosis~~==		==Evaluation==
	*Pain, erythema, swelling distal to constricting ring of foreskin		*Pain, erythema, swelling distal to constricting ring of foreskin