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Paraphimosis may be defined as a rare condition characterized by a trapped penis foreskin behind the glans penis that is difficult and painful to be pulled back to its original flaccid position. It is a problem that affects only uncircumcised male penis or even ones which are partially circumcised. It may either be mild or severe by nature as it may normalize by itself or may be considered a urologic emergency as the blood flow may be restricted causing the death of the tissues.
Although phimosis and Paraphimosis are related to the same organ, the former may be differs from the latter in the sense that phimosis may be reported when the foreskin of the penis cannot be retracted behind the glans. It is in fact, the opposite of Paraphimosis. Paraphimosis in children and the elderly is quite common.
The symptoms of Paraphimosis include the penis foreskin retraction to the swollen penile glans, a swollen penis, pain and difficulty in pulling the retracted penis skin.
In case of Paraphimosis in children one may exhibit infant penile swelling, which may manifest in causing acute urinary tract obstruction. In severe cases such as prepuce adhesions, one may also experience bleeding from the site affected.
The causes of Paraphimosis may either be iatrogenic or inadvertent. However, the main causes of Paraphimosis lie basically in the poor handling of the penis in hospitals and at home. One may leave the penis in the retracted condition after cleaning and examining the penis, or after a cystoscopy or a urethral catheterization. Such retraction impairs the blood and lymphatic flow from the prepuce and the glans penis, thereby leading to the swelling of the foreskin tissue of the penis. It may also be triggered by a penile infection or piercing or even a urethral injury.
In fact, in case of balanitis Paraphimosis, one also exhibits foul smell from the penis caused due to an edema of the penile glans. The worsening of the edema restricts the flow of blood through the eyes and may lead to vascular engorgement or tissue ischemia.
Paraphimosis may also be caused due to vigorous and uncontrolled sexual intercourse or due to erections. Congenital phimosis and preputial adhesions may also be cited as a significant cause of the same.
Paraphimosis may be diagnosed by physically examining the penis for overt and noticeable symptoms. Usually, the urologist detects a doughnut around the penile shaft. But one has to be careful while handling the penis because any kind of mishap may further aggravate the problem and give rise to severe complications.
The treatment of Paraphimosis depends on the symptoms and the cause of the same. There are several forms of treatment for Paraphimosis which may be sub-classified as manual and surgical procedure.
One can manually treat Paraphimosis by manipulating the swollen penis foreskin. This is done by compressing the penis head or the penis glans while the foreskin is pushed forward, thereby trying to bring the prepuce to normalcy. This is aided by the application of lubricants or softeners for the purpose of softening the skin, and also applying cold compression over the penis. Intravenous sedation with midazolam or morphine, administration of anaesthesia such as lidocaine and application of granulated or hypertonic sugar, and adult phimosis treatment also facilitates the manual treatment of Paraphimosis.
This process helps the penis to get back to its original position and facilitates Paraphimosis reduction. Along with these, hyaluronidase and osmotic agents have also proved efficient for swollen foreskin treatment. These are injected into the edematous prepuce and specially help in case of Paraphimosis in children. Besides, timely phimosis treatment in children also prevents the occurrence of the risk of Paraphimosis.
The surgical method for the treatment of Paraphimosis comprises of several other procedures such as blood aspiration, puncture therapy and invasive procedure.
A blood aspiration is conducted after the application of tourniquet over the penis. This entails the measurement and analysis of the blood that aspires in the blood vessels of the penis.
The puncture technique is conducted using an 18 to 21 gauge hypodermic needle. It is used to puncture the prepuce at very many sites so as to allow the fluid trapped to drain out. This method is also known as Perth-Dundee method and is minimally invasive by nature.
However, when all such measures are not able to deal with a constricted penis problem, urologists may have to resort to the last option, i.e., the dorsal slit procedure or circumcision.
The dorsal slit procedure is conducted by draping the penis in a fashion sterile and then identifying the cicatrical ring of a size not more than 5-10mm thick. But this must be done by keeping the penis glans away from the site of incision by retracting it. This is followed by crushing the ring with a haemostat at an angle of 90 degrees and then cutting the same. Sutures are also placed to control any kind of bleeding that may take place when the ring is incised. This method aids the process of reducing the prepuce.
Circumcision and conservative therapy are the other definitive therapies for Paraphimosis. Circumcision is mostly done in case of balanitis Paraphimosis. The prognosis of Paraphimosis is minimal if one undergoes a proper circumcision.
However, it must be kept in mind that although Paraphimosis does not seem to be a serious problem, its ignorance can lead to gangrene and other serious urologic complications which may severely affect one’s mental, physical and sexual health.