Paraphimosis 

• Paraphimosis is a urological emergency and brings a risk of preputial necrosis 
• Paraphimosis occurs when the foreskin is left in the retracted position. The foreskin distal to the tight area becomes oedematous which makes it difficult to reduce the foreskin over the glans
• 3 Goals
  • Manage Pain
  • Decrease Swelling
  • Reduce
• Pain
  • Give oral analgesia and reassurance
  • Topical Gels – Emla
  • Dorsal Penile Block – lidocaine at 10 or 2 o’clock  
• Decrease Swelling
  • Apply Osmotic aget
    • 20% Mannitol, Granulated Sugar dissolved in water, D50W
    • Soak gauze and wrap around the foreskin, or put inside condom or glove andapply directly
  • Then Compress
    • Wrap a firm compression bandage (ideally 1 inch, for example Coban, pictured) over the oedematous area, starting at penile tip 
    • Leave bandage for 10-15 minutes (use a timer)

• Manual Reduction
  • Remove bandage
  •  attempt to reduce foreskin over the glans  
  • If unsuccessful, repeat bandage for further 15 minutes and re-attempt 
  • If manual reduction fails, obtain urgent surgical consult

• Post reduction care:
  • Circumcision is not indicated and follow-up is not necessary
  • Advise the child and parents to avoid a repeat event:
    • No retraction for a few days
    • Only the child to retract foreskin for cleaning
    • Ensure immediate complete replacement of foreskin over glans
  • Children with evidence of ischaemia (dusky or dark tissue) require urgent review by a urologist