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Paraphimosis: True Urologic emergency

Paraphimosis: True Urologic emergency
FB Dr Soarawee
Soarawee Weerasopone, MD

Andrologist
Royal Phnom Penh hospital, Kingdom of Cambodia

The paraphimosis is one among another urologic emergency issue that I’ve been experienced frequently at the emergency room. It is a condition when the penile foreskin stuck behind the head of glans penis. It happens more frequently in uncircumcised gentlemen. Today we will talk more details on the etiology and the proper management of this urologic emergency condition.

Paraphimosis: True Urologic emergency
Most of paraphimosis issues happen from man-made situations.

Etiologies of Paraphimosis

Paraphimosis is commonly caused by man-made situations. It is where the foreskin cannot be returned over the glans penis after being retracted. Below are a fewer examples of the foreskin retraction activities that can be happened.

  • Retracted foreskin routinely for penile cleaning
  • Retracted foreskin Incidentally after sexual activity
  • Retracted foreskin for inserting urinary catheter
  • Retracted foreskin for penile examination
  • Retracted foreskin for urologic procedure

Symptoms

Severe pain, swelling and erythematous of penile foreskin and glans penis are the typical features. The swelling skin is happened from a stuck foreskin which makes venous and lymphatic drainage impairment. Generally, it won’t affect the arterial blood flow, in the meantime, if this condition is persisted for days, it will make the arterial drainage compromised then potentially, it can lead to a loss of glans penis.

Paraphimosis: True Urologic emergency
Paraphimosis is a true Urologic emergency.

Emergency management

  • Uncomplicated type can be managed with manually reduction. The choice of sedation of analgesia is depended on individuals.
  • Complicated type is considered when manually reduction methods are failed or significant complications are happened at the glans penis or the urethra. The choices of treatment are being shown as below.
    • Surgical incision at the constricted foreskin
    • Suprapubic urine drainage with surgical dead tissue removal
Paraphimosis: True Urologic emergency
All patients with a history of this should consider elective circumcision.

Elective management

All patients with the history of paraphimosis are recommended to do the circumcision due to high rate of recurrence.

Despite the paraphimosis is quite rare condition (1% risk was reported in adults) but an improper management might leads to a serious complications sometimes. If you have any questions, talk to your trusted urologist, or it would be my pleasure if you text me. Be safe from paraphimosis!

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