Penile dorsal slit: Difference between revisions
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==Procedure==
==Procedure==
#prep and drape penis in sterile fashion
*Prep and drape penis in sterile fashion
#raise a wheal of anesthesia in the foreskin, just proximal to the glans on the dorsal aspect of the penis (27-gauge needle)
*Using a 27 gauge needle, raise a wheal of anesthetic in the foreskin
#Extend the injection along the longitudinal axis distally to the tip of the foreskin
**Just proximal to the glans on the dorsal aspect of the penis
#After 4 min, check to make certain the anesthesia is effective
#Extend the injection along the longitudinal axis until entire foreskin is anesthetized
#Slide the hemostats along the space between the foreskin and the glans, and gently open, forming a tract.
#After 4 min, check effectiveness of anesthetic
#Remove the hemostats, then replace with one tip between the foreskin and glans, and one tip outside the foreskin, straddling the region of anesthesia. Make certain the tip of the hemostats is not in the urethral meatus.
#Slide closed hemostat between dorsal penis and foreskin
#Close the hemostat over the region of anesthesia and keep clamped for 10 min.
#Gently open hemostat to create a tract
#Remove the hemostat, and cut the serrated clamped tissue with the scissors.
#Remove hemostat
##(If the skin edges continue to ooze, a running stitch using a vicryl suture can be placed on each side)
#Open hemostat and insert bottom prong along previously created tract with top prong above the foreskin
#Retract the foreskin and clean the glans  
#*Carefully ensure that hemostat is not in urethral meatus
##(Place a Foley catheter when indicated)
#Close hemostat to crush foreskin tissue
#Leave hemostat in place for 10 minutes
#Remove hemostat
#Use iris scissors to cut crushed tissue
#Use vicryl to place a running stitch along cut ends of foreskin if oozing is excessive or persistent
#Clean glans
#Place Foley catheter if needed


==Complications==
==Complications==

Revision as of 20:41, 15 May 2019

Indications

  • Relieve paraphimosis
    • After failure of non-invasive reduction
    • Emergent urology consult not available
  • Phimosis causing urinary retention

Contraindications

  • No absolute contraindications
  • Should be performed by urologist if consultation is immediately available
  • Caution when:
    • Evidence of overlying infection
    • Patient immune compromised
    • Patient has coagulation disorder

Equipment Needed

  • Betadine or other antiseptic prep solution
  • Sterile gloves and drape
  • Local anesthetic
  • 27 gauge needle
  • 3cc syringe
  • Straight hemostats or Kelly clamp
  • Iris scissors
  • Vicryl suture (3-0 or 4-0)
  • Needle driver
  • Gauze

Procedure

  • Prep and drape penis in sterile fashion
  • Using a 27 gauge needle, raise a wheal of anesthetic in the foreskin
    • Just proximal to the glans on the dorsal aspect of the penis
  1. Extend the injection along the longitudinal axis until entire foreskin is anesthetized
  2. After 4 min, check effectiveness of anesthetic
  3. Slide closed hemostat between dorsal penis and foreskin
  4. Gently open hemostat to create a tract
  5. Remove hemostat
  6. Open hemostat and insert bottom prong along previously created tract with top prong above the foreskin
    • Carefully ensure that hemostat is not in urethral meatus
  7. Close hemostat to crush foreskin tissue
  8. Leave hemostat in place for 10 minutes
  9. Remove hemostat
  10. Use iris scissors to cut crushed tissue
  11. Use vicryl to place a running stitch along cut ends of foreskin if oozing is excessive or persistent
  12. Clean glans
  13. Place Foley catheter if needed

Complications

  1. bleeding
  2. pain
  3. infection
  4. damage to glans or urethra

See Also

References

Emedicine

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