What Is The Best Way To Treat Paraphimosis?

Paraphimosis refers to a potentially serious urologic condition which is seen normally in uncircumcised males or those who are partially circumcised. In Paraphimosis, the foreskin stays retracted behind the glans and forms a tight ring of tissues. If it is left untreated then it can have serious implications. Reducing the foreskin to its anatomical position following foreskin manipulation is the key in preventing paraphimosis. When paraphimosis is suspected, prompt evaluation and treatment should be undertaken to prevent unforeseen consequences.

Paraphimosis is diagnosed keeping into consideration the history as well as penile examination of the patient. Paraphimosis is a medical emergency condition and appropriate steps should be undertaken to resolve the condition and prevent the loss of tissue.

Paraphimosis is divided into acute type without ischemia and necrosis, acute type with ischemia and necrosis and chronic type without ischemia and necrosis. The best way to treat paraphimosis revolves around the following classification.

Acute type without any signs of ischemia and necrosis can be resolved with manual manipulation of the penis. In manual manipulation, the foreskin is reduced to its original position following administration of a local anesthetic/analgesic to reduce the pain symptoms during the procedure. The reduction of swelling can also be achieved by applying ice pack to the penis or by using compression technique in which the glans and foreskin is compressed for about 5-30 minutes to alleviate the swelling and reducing the foreskin to its normal position. In addition, osmotic agents such as fine granulated sugar can also be used to reduce the swelling of the glans.

If reduction is not achieved with manual manipulation, then puncture technique can be employed to reduce the foreskin, which is a minimally invasive technique. After local anesthesia or analgesic, a 22 gauge needle is used to perforate the foreskin at various locations, also known as Dundee technique, for the removal of the edematous fluid and subsequent reduction of the foreskin manually. In addition, hyaluronidase can also be used as an adjunct to puncture technique for the decreasing edema of the foreskin. Hyaluronidase works by breaking down hyaluronic acid present in the foreskin, which helps in alleviating edema, thus manual compression and reduction can be achieved easily following alleviation of swelling.

If conservative options including manual manipulation and puncture technique are unsuccessful, then paraphimosis is treated by surgical reduction followed by circumcision. After the local anesthesia or general anesthesia, an incision is made in the foreskin and excision of phimotic ring is done on the dorsal aspect of penis to release the foreskin and the swelling so that it can be reduced to its normal anatomical position. After the resolution of edema, a second procedure is carried out for circumcision.

Acute type with ischemia and necrosis requires emergency surgery aiming at reduction of the foreskin to its anatomical position along with debridement of the necrotic tissue and preservation of the healthy tissue.

Chronic type paraphimosis without ischemia or necrosis also requires surgical reduction followed by circumcision.

If prompt treatment is not given then it may lead to gangrene formation and may also result in autoamputation of the glans in several days to weeks. Thus, it is important to consider immediate treatment for paraphimosis without neglecting the signs and symptoms and visiting a healthcare professional if it is suspected.

In most cases, the etiology of paraphimosis usually is iatrogenic or inadvertently induced by a healthcare specialist after an examination of the penile area, cystoscopy, or urethral catheterization. People who have a Foley catheter placed tend to be vulnerable to Paraphimosis since the process of insertion of this urethral catheter warrants the foreskin to be retracted for preparation and draping of glans. Once the catheter is inserted the physician may not get the foreskin back to normal anatomical position.

Other rare causes of paraphimosis include partial circumcision, self-inflicted damage like piercing of a ring in the penile area, varying sexual activities, poor personal hygiene, diabetes and recurrent bacterial infections.