Paraphimosis

Definition

Paraphimosis is a purely male pathological condition, in which, following the glans extrusion due to an erection, the foreskin is no longer able to return to status quo ante . Paraphimosis, when not treated promptly, could develop into gangrene.

Clearly, the paraphimosis involves only the uncircumcised males: at the level of the balano-preputial sulcus, the member appears literally strangled by the foreskin which, once retracted, has assumed a ring conformation.

Paraphimosis and related disorders

Generally, paraphimosis is closely related to phimosis: by refining the concept, in many patients with unfixed phimosis (a condition in which a clearing of the glans is possible, albeit partial), the foreskin discovers the glans during erection but, subsequently, the preputial leaflet is no longer able to return to the resting position. [taken from www.fimosi.com].

In paraphimosis, the preputial ring tightens the glans, suffocating it: consequently, the likelihood of edema in the site is very high. But that's not all, as this condition could cause urinary retention, an event following the compromise of the urethral canal.

In cases of severity, paraphimosis could cause an ulcer and, when untreated, venous stasis of the glans or even gangrene.

When the paraphimosis degenerates, it could favor the occlusion of the genital arteries, therefore ischemic necrosis of the glans: it is an extreme situation, therefore rare even if [taken from pediatric surgery. Approach and management of the child with surgical problems of GB Paris]

Causes

Searching among the possible etiological factors responsible for paraphimosis, phimosis stands out, caused, in turn, by chronic metabolic alterations (eg diabetes), poor hygiene and recurrent bacterial infections.

Sometimes, even the balanites, balanopostites and posts can represent the expedient for the manifestation of paraphimosis.

Incidence

Unfortunately, paraphimosis is not uncommon, on the contrary: many patients, admitted to the urology department after a physical trauma / intervention, are denied the possibility of bringing the foreskin back to rest, (wrapping the glans) after an erection .

The subjects most at risk of paraphimosis are the elderly and children, particularly those who are not circumcised.

Symptoms

To learn more: Paraphimosis symptoms

In the clinical picture derived from paraphimosis, one can often notice an evident inflammation, the causes of which go back to both bacterial infections and to genital traumatic events.

The foreskin, by throttling the glans, causes a progressive inflammation related to edema; the patient complains of highly painful sensations (some call the pain "excruciating and unbearable") not only at the level of the glans, but throughout the body of the penis.

Diagnosis and therapies

The diagnosis of paraphimosis is almost simple: the subject is unable to cover the glans again with the preputial leaflet. It is absolutely essential to go to a hospital or private clinic as quickly as possible because paraphimosis is a urological emergency in all respects: as we have analyzed, underestimating the disorder and delaying consulting the doctor are errors that could cost the patient dearly.

First of all, the subject complaining of paraphimosis is advised to perform some manual practices:

• Tighten the glans for a few minutes with both hands, compress the foreskin in order to reduce the edema and, at the same time, progressively push on the glans to reach a reduction situation. [taken from pediatric surgery. Approach and management of the child with surgical problems of GB Paris]
• Dundee technique: try to deflate the edema through the repetition of narrow at the glans and delicate punctures of the same with a thin needle

It is advisable to consult the specialist (urologist, in general), who will provide for the preputial retraction and the exit of accumulated oedematous fluid. When, despite manual practices, the foreskin cannot cover the glans, surgery is recommended (surgical reduction under local / general anesthesia, surgical circumcision).

Circumcision can be an excellent practice aimed at the prophylaxis of paraphimosis.

Prognosis

When the patient presenting paraphimosis turns immediately to the doctor, the prognosis is excellent in most cases; when, however, paraphimosis is not treated, the damage can be very serious: gangrene, damage or loss of the tip of the glans and hemostasis at the level of the balano-preputial sulcus. In this regard, medical supervision is essential from the very first symptoms of paraphimosis.

Summary

Paraphimosis: in short

Disorder	Paraphimosis
Description	Male pathological condition: after extrusion of the glans due to erection, the foreskin is no longer able to wrap the barnacle again.
Paraphimosis related disorders	phimosis throttling of the glans → edema formation → impairment of the urethral canal → urinary retention extreme cases: ulcer glans stenosis → occlusion of the genital arteries → gangrene / ischemic necrosis of the glans
Causes of paraphimosis	phimosis; Chronic metabolic alterations (eg diabetes); Poor hygiene and recurrent bacterial infections; Balanitis and balanopostites
Incidence of paraphimosis	The subjects most at risk of paraphimosis are the elderly and children
Symptomatic picture of paraphimosis	Obvious inflammation; Edema; "Lancinating and unbearable" pain for the whole body of the penis
Therapeutic strategies for paraphimosis	Manual and technical Dundee practices; The urologist ensures that the foreskin is retracted and the edematous liquid is released; Surgical reduction; Circumcision
Prognosis	Excellent, when it comes to the doctor since the very first symptoms of paraphimosis Severe outcome when paraphimosis is not treated (gangrene, damage or loss of the tip of the glans and haemostasis at the level of the balano-preputial sulcus)