Summary
Definition
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 edema of the distal glans.[1] This condition is a medical emergency when identified acutely and requires prompt effective treatment to prevent loss of the distal glans penis.[2][3][Figure caption and citation for the preceding image starts]: Diagram illustrating paraphimosisFrom the collection of Dr Ranjiv Mathews [Citation ends].
History and exam
Key diagnostic factors
- penile pain
- band of retracted foreskin tissue beneath the glans
- swollen glans penis
- indwelling catheter
Other diagnostic factors
- erythema
- black tissue on the glans
- nonpliable glans penis
- inability to urinate freely
Risk factors
- lack of circumcision
- urinary catheterization
- dependence on a caregiver for daily hygiene
- tight foreskin
- phimosis
- poor hygiene
- bacterial infection
- parasitic infections
- lichen sclerosis
- diabetes
- penile piercing
- hemangiomas of the penis
- peripheral vascular disease
- inadequate circumcision
Diagnostic tests
1st tests to order
- clinical diagnosis
Treatment algorithm
with ischemia and necrosis
acute type without ischemia and necrosis
chronic type without ischemia and necrosis
Contributors
Authors
Ranjiv Mathews, MD
Associate Professor
Pediatric Urology
SIU School of Medicine
Springfield,
IL
Disclosures
RM declares that he has no competing interests.
Peer reviewers
Wesley Baas, MD
Assistant Professor of Urology
University of Cincinnati College of Medicine
Cincinnati
OH
Disclosures
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
Nashville
TN
Disclosures
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
Addenbrooke's Hospital
Cambridge
UK
Disclosures
VG declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
European Association of Urology. Paediatric urology. Mar 2022 [internet publication].Full text
Manjunath AS, Hofer MD. Urologic emergencies. Med Clin North Am. 2018 Mar;102(2):373-85. Abstract
British Association of Paediatric Urologists. Management of foreskin conditions. 2017 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Allergic reactions
- Insect bites
- Tourniquet syndrome
More DifferentialsGuidelines
- Paediatric urology
- Management of foreskin conditions
More Guidelines
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