Internal Medicine

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

1170 Phimosis and Paraphimosis

exposing glans and urethral meatus. Elective circumcision accom-

plished at a later date.

Paraphimosis

■Management must be immediate.

■Using analgesics and gentle, firm traction, foreskin may be drawn

distally over the edematous coronal sulcus with immediate relief.

■Edema takes several hours to resolve. Manual compression using

the hand or a pediatric blood pressure cuff around the penile shaft

to squeeze out edema also a useful technique. Manual traction

may result in successful replacement of the foreskin to normal

position.

■If these measures fail, emergency dorsal slit may be necessary.

specific therapy

Phimosis

■If foreskin cannot be retracted for hygienic and inspection purposes,

circumcision recommended

Paraphimosis

■Management must be immediate.

■Manual compression technique described above.

■If previously mentioned measures fail, emergency dorsal slit may be

necessary.

follow-up

Phimosis and Paraphimosis

■Ensure that foreskin can be retracted.

■If not possible, circumcision recommended

■If circumcision is done and no neoplasia, no long-term follow-up

necessary post-operatively

complications and prognosis

Phimosis

■Left untreated, long-term complications may include higher inci-

dence of squamous cell carcinoma

Paraphimosis

■Left untreated, long-term complications include continued vascular

congestion with edema, possible partial necrosis of penile skin