Penile dorsal slit

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

Single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue.

1. Prep and drape penis in sterile fashion
2. 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
3. Extend the injection along the longitudinal axis until entire foreskin is anesthetized
4. After 4 min, check effectiveness of anesthetic
5. Slide closed hemostat between dorsal penis and foreskin
6. Gently open hemostat to create a tract
7. Remove hemostat
8. 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
9. Close hemostat to crush foreskin tissue
10. Leave hemostat in place for 10 minutes
11. Remove hemostat
12. Use iris scissors to cut crushed tissue
13. Use vicryl to place a running stitch along cut ends of foreskin if oozing is excessive or persistent
14. Clean glans
15. Place Foley catheter if needed

Complications

• Bleeding
• Pain
• Infection
• Damage to glans or urethra

See Also

• Paraphimosis Reduction
• Phimosis
• Paraphimosis

References

Emedicine