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Paraphimosis: Causes, Symptoms and Treatment

Paraphimosis is a urological emergency in which the retracted foreskin becomes trapped behind the glans penis, causing swelling and cutting off blood flow.

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Things worth knowing about "Paraphimosis"

Paraphimosis is a urological emergency in which the retracted foreskin becomes trapped behind the glans penis, causing swelling and cutting off blood flow.

What is Paraphimosis?

Paraphimosis is an acute urological emergency that occurs when the foreskin of the penis is retracted behind the glans (head of the penis) and cannot be returned to its normal position. The trapped foreskin acts like a tourniquet, restricting blood and lymphatic flow to the glans. Without prompt treatment, this can lead to tissue death (necrosis) and permanent damage.

Causes

Paraphimosis almost always occurs in the context of an existing phimosis (a narrowing of the foreskin). Common triggers include:

Retraction of the foreskin during personal hygiene or sexual activity without replacing it afterward
Medical procedures such as catheter insertion or genital examinations where the foreskin is retracted and not returned to its original position
Penile piercings that cause local swelling
Inflammatory conditions that narrow the foreskin

Symptoms

The symptoms of paraphimosis typically develop rapidly and are easily recognizable:

Pain in the area of the glans and foreskin
Marked swelling of the glans due to congestion of blood and lymphatic fluid
A visible constricting ring of foreskin tissue behind the glans
Discoloration of the glans (bluish-red) due to impaired blood supply
In advanced cases: numbness or signs of tissue damage

Diagnosis

Paraphimosis is a clinical diagnosis based on physical examination. The characteristic finding of a constricting ring behind the swollen glans is unmistakable. Imaging studies are generally not required. It is important to differentiate paraphimosis from other causes of penile swelling, such as angioedema or balanoposthitis (inflammation of the glans and foreskin).

Treatment

Paraphimosis is a medical emergency and must be treated as quickly as possible. The goal is to return the foreskin to its normal position over the glans (manual reduction).

Conservative (Non-Surgical) Treatment

In many cases, paraphimosis can be resolved without surgery:

Manual compression: The physician applies firm pressure with both thumbs to compress the swollen glans, reducing the edema, and then gently slides the foreskin back into place.
Cold compresses: Applying ice or cold packs to the area can help reduce swelling before manual reduction.
Puncture technique (Ostergren technique): Multiple small needle punctures are made into the swollen glans to release fluid and facilitate reduction.
Local anesthesia: A penile nerve block may be used to reduce pain and allow for easier manipulation.

Surgical Treatment

If conservative measures fail or tissue damage has already occurred, a surgical procedure is required. This involves making a dorsal slit incision through the constricting foreskin ring under anesthesia. Following the acute episode, circumcision is often recommended to prevent recurrence.

Prevention

The most important preventive measure is to always return the foreskin to its natural forward position after retraction. In patients with known phimosis, early treatment of the condition significantly reduces the risk of paraphimosis.

References

Morales Lopez A. et al. - Paraphimosis: pathophysiology, diagnosis and management. BJU International, 2020.
Palmieri A. et al. - Paraphimosis: current treatment options. Urology, 2019.
European Association of Urology (EAU): Guidelines on Urological Infections and Emergencies. www.uroweb.org

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