Phimosis is the inability to retract the foreskin over the
glans, and is usually due to a contracted preputial opening.
Patients with phimosis may seek acute medical care when they
develop signs and symptoms of infection, such as pain and
swelling of the foreskin and a purulent discharge.
Paraphimosis occurs when the foreskin cannot be replaced in
its normal position after it is retracted behind the glans.
The tight ring of preputial skin which is caught behind the
glans creates a venous tourniquet effect and leads to
edematous swelling of the glans.
What to do:
For paraphimosis, squeeze the glans firmly for at least
ten minutes to reduce the edematous swelling. Wrap the shaft and swollen glans with a gauze pad followed by a two inch elastic bandage that will produce constant, gentle compression. After ten to fifteen minutes, remove it, then push
the glans proximally and slide the prepuce back over the
glans. If manual reduction fails, anesthetize the dorsal foreskin and carefully incise the constricting tissue.
Treating phimosis usually involves the management of acute
infection. Frequent hot compresses or soaks are needed
along with antibiotics such as cefadroxil (Duricef) for a balinitis.
In both paraphimosis and phimosis, followup care should be
provided. When swelling and inflammation subside,
circumcision should be performed.
Poor hygene and chronic inflammation are the usual causes
of stenosing fibrosis of the preputial opening. In the case
of a neglected paraphymosis, arterial occlusion may
supervene and gengrene of the glans develop. When phimosis results in acute urinary retention, the tip of a hemostat can be inserted into the scarred end of the foreskin and gently opened, allowing the patient to void satisfactorily until urologic cosultation can be obtained. One common cause of paraphymosis is retracting the foreskin to clean the glans and place a Foley catheter, but forgetting to reduce the foreskin afterwards.