Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:57

Pheochromocytoma Phimosis and Paraphimosis 1169

Prognosis

■Benign pheochromocytoma:

➣Complete resection cures hypertension in 75%

➣Patients may remain hypertensive despite normal cate-

cholamine levels

■Malignant pheochromocytoma:

➣50% 5-y mortality

PHIMOSIS AND PARAPHIMOSIS

KEY H. STAGE, MD, FACS

history & physical

Signs & Symptoms of Phimosis

■May be congenital or acquired, incidence 1% males >16 yrs

➣Foreskin cannot be retracted behind the glans penis

➣Normal in boys under age 4, even into early teens

➣Usually not painful, but may result in difficulty voiding, balloon

appearance of distal foreskin with voiding due to obstruction

Signs & Symptoms of Paraphimosis

■Foreskin has been retracted behind the glans penis/coronal sulcus

■If not reduced, vascular engorgement with swelling and pain

tests

■Physical examination alone is sufficient for diagnosing phimosis and

paraphimosis.

differential diagnosis

■Phimosis may be congenital or a result of trauma, forceful retraction

of congenital phimosis, inflammation, poor hygiene.

■Paraphimosis is often iatrogenic, due to health care personnel care-

lessly leaving foreskin retracted, i.e., in a patient with a Foley catheter,

chronic balanoposthitis, vigorous prolonged intercourse, popularity

of body piercing.

management

Phimosis

■Initially consists of topical cream and warm soaks for patient comfort

■If difficulty voiding, a dorsal slit may be performed in an emergency

situation – dorsal aspect of foreskin incised using local anesthesia,