Paraphimosis is a condition caused when the foreskin of an uncircumcised penis is retracted and left behind the glans, leading to vascular engorgement and oedema of the distal glans.
In its acute form, it is a medical emergency requiring rapid evaluation and possible surgical decompression.
Can occur at any age but is most common in children and older people.
Circumcision is preventive and is curative if the process develops.
Most cases are iatrogenic in aetiology.
Paraphimosis is a condition caused when the foreskin of the uncircumcised penis is retracted and left behind the glans penis, leading to vascular engorgement and oedema of the distal glans. This condition is a medical emergency when identified acutely and requires prompt, effective treatment to prevent loss of the distal glans penis.
History and exam
Key diagnostic factors
- presence of risk factors
- penile pain
- band of retracted foreskin tissue beneath the glans
- swollen glans penis
- indwelling catheter
Other diagnostic factors
- black tissue on the glans
- non-pliable glans penis
- inability to urinate freely
- lack of circumcision
- urinary catheterisation
- dependence on a carer for daily hygiene
- tight foreskin
- poor hygiene
- bacterial infection
- parasitic infections
- lichen sclerosis
- penile piercing
- haemangiomas of the penis
- peripheral vascular disease
- inadequate circumcision
1st investigations to order
- clinical diagnosis
with ischaemia and necrosis
acute type without ischaemia and necrosis
chronic type without ischaemia and necrosis
Ranjiv Mathews, MD
SIU School of Medicine
RM declares that he has no competing interests.
Wesley Baas, MD
Assistant Professor of Urology
University of Cincinnati College of Medicine
WB declares that he has no competing interests.
John Thomas, MD
Assistant Professor of Urologic Surgery
Division of Pediatric Urology
Monroe Carell Jr. Children's Hospital at Vanderbilt
JT declares that he has no competing interests.
Vincent Gnanapragasam, MBBS, BMedSci, PhD, FRCSEng, FRCSEd(Urol)
Lecturer in Uro-oncology and Consultant Urological Surgeon
Department of Urology
VG declares that he has no competing interests.
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