Management of a Paraphimosis Dr. P.T.Kenny.

Introduction Paraphimosis implies the inability of the retracted constricting foreskin to be reduced over the glans. Oedema distal to the constriction is a complicating factor which has to be addressed. Reduction is painful without some form of anesthesia and can also be time consuming when using certain techniques. Reduction can be done in theatre under GA, or in a consulting room under local anesthesia. (Phimosis is a constriction of the foreskin which cannot be retracted).

Reduction of the paraphimosis You need to obtain the patient’s co-operation and trust in you. Explain your planned actions to the patient. Using 1or 2% lignocaine (without adrenaline!!), do a ring block at the base of the penis. Clean the glans with Hibitane in water. Then puncture a few holes in the oedematous tissue, using a 21G needle. Cover the glans with gauze swabs or a piece of linen saver. Now squeeze the glans firmly to drain the oedema. Retract the foreskin over the glans of the penis. A circumcision can be planned for later if deemed necessary. Sometimes it is necessary to cut through the constricting band dorsally (the penis is then already anaesthetized).

Remarks Never attempt this procedure without first doing a ring block of the penis. Don’t ask unnecessary questions! And keep your comments to yourself! The young man (patient) feels guilty and ashamed enough!!!