What Is The Prognosis For Paraphimosis?
Paraphimosis is also known as Spanish collar. It is a condition in which the foreskin (prepuce) stays in a retracted position behind the glans penis. Prolonged retraction of the foreskin behind the penis leads to edema of the foreskin and the glans with secondary vascular engorgement leading to ischemia of the glans. It is a medical emergency and requires immediate medical attention and treatment. If left untreated, then it may lead to necrosis and gangrene with subsequent autoamputation of the glans penis.
What is The Prognosis for Paraphimosis?
Paraphimosis is a rare condition, which needs to be addressed immediately; otherwise it may lead to gangrene of glans and subsequently auto-amputation of the glans penis. However, prompt medical treatment with successful reduction of the foreskin to its anatomical position has an excellent prognosis. The prognosis also depends on the underlying etiology leading to paraphimosis. The delay in treatment will subsequently worsen the prognosis.
The complications of paraphimosis include necrosis and gangrene of the glans and subsequent autoamputation of the tip of the penis.
Paraphimosis can be prevented by reducing the foreskin to its anatomical position after clinical examination, cystoscopy and catheter placement. It can also be prevented by maintaining good personal hygiene and treating any recurrent infections. Cleaning the genitals may help in maintaining personal hygiene in the long run. Refraining from varying sexual activities as well as penile piercings/rings can also prevent paraphimosis. It can also be prevented by circumcision and prompt medical attention. Once encountered, care should be taken to avoid forcibly pulling the foreskin over the glans penis as this might complicate the situation further instead of resolving it.
What is The Treatment for Paraphimosis?
The treatment of paraphimosis depends on the severity of the condition. It can be initiated with a conservative approach after application of local anesthesia. The conservative approaches employed include manual manipulation to reduce the foreskin to its normal anatomical position. Ice packs or compression of the glans can be undertaken to reduce the edema, so that the reduction of foreskin can be achieved without much difficulty. If manual manipulation fails, then puncture technique can be employed in which the foreskin is punctured at several points in the foreskin for the outlet of edematous fluid. Hyaluronic acid injection can be used as an adjunct to puncture therapy to reduce edema. If conservative methods are unsuccessful at reducing the foreskin, then surgical reduction along with circumcision is the last resort. Surgical reduction requires incising the phimotic ring of the foreskin, so that reduction can be achieved easily under the influence of general/local anesthesia.
What is The Pathophysiology of Paraphimosis?
The entrapment of foreskin behind the glans penis over a prolonged period of time can lead to formation of a tight and constricting band of tissue. This constricting band of tissue can interfere with the blood and lymphatic flow to and from the glans and prepuce. This can result in vascular engorgement and reduced blood flow to the glans leading to secondary inflammation of the glans and foreskin. If no heed is paid to this, then it can lead to ischemia and necrosis resulting in gangrene and autoamputation of the glans penis in several days to weeks.
What are The Symptoms of Paraphimosis?
Paraphimosis presents as an inflammation of the foreskin and glans penis. This leads to redness, swelling, discomfort and pain in the area without involvement of the shaft of penis. The foreskin stays retracted with the presence of a phimotic ring behind the glans penis. Infants and children usually present with symptoms of urinary obstruction with a sensation of incomplete voiding, weak urinary stream and delayed voiding. The glans penis may turn blue black with ischemia and start showing signs of necrosis, if left untreated. If not followed by a doctor, then it may lead to gangrene and autoamputation of the glans penis.