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
