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7.10 Phimosis and Paraphimosis


Presentation

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:

Discussion

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.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
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