Paraphimosis

• Paraphimosis is the inability to completely reduce the penile foreskin distally, back to its natural position overlying the glans penis. This condition occurs exclusively in uncircumcised males and is a urologic emergency.

Manual Reduction

1. Apply a topical anesthetic lubricant to the distal penis (foreskin and glans).
2. Administer a systemic analgesic (optional).
3. Compress the foreskin and glans with a snugly grasped hand.
4. Use the thumbs to invert the glans penis proximally through the phimotic ring.
5. Use the index and long fingers to reduce the phimotic ring distally.
6. If unsuccessful, try alternate maneuvers to reduce edema before reattempting manual reduction.
7. Consider an optional trial of glans adjuncts:
8. administer an ice pack or
9. a compressive bandage to reduce glans edema.
10. Consider an optional trial of foreskin adjuncts:
11. administer micropuncture wounds,
12. use sugar, or
13. use hyaluronidase to reduce foreskin edema.
14. If unsuccessful, reduce the paraphimosis surgically by dorsal slit or definitive circumcision.
15. Arrange urgent urology follow-up following reduction.

Methods to reduce Swelling for manual reduction

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Alternative Techniques other than Manual reduction