Reduction of paraphimosis
First Aid for the Emergency Medicine Clerkship.
Jump to section, when the foreskin becomes trapped behind the corona for a prolonged time, it may form a tight, constricting band of tissue.
Paraphimosis is one of the few urologic emergencies that may be encountered in general practice.
Non-surgical stretching of the foreskin may be used to widen a narrow, non-retractable foreskin.After insertion of the catheter, the practioner may not return the retracted foreskin to its normal position.This procedure should be performed with the use of a local anesthetic by a physician experienced with the technique.The base of the foreskin is the location of the constricting or phimotic ring (.The physical examination should focus on the penis, urethral catheter (if present) and scrotum.A pink or salmon hue to the glans indicates a good blood supply.Treatment often begins with reduction of edema, followed by a variety of options, including mechanical compression, pharmacologic therapy, puncture technique and dorsal slit.Latha Ganti Stead;.Figure 2 topical analgesic or oral narcotics before penile manipulation.If left untreated, penile gangrene and autoamputation may follow in days or weeks.However, the reason for the initial placement of the catheter should be obtained first cadeau cinéma original so that, if necessary, it can be replaced following reduction of the paraphimosis.
These superficial arteries do not communicate with the deep arteries of the penis.
A retracted foreskin will block lymphatic drainage from the distal penis.
Figures 148-1 148-2 ).This predisposes them to a paraphimosis when well-meaning caregivers forcibly retract the foreskin during cleaning.The process may have a more indolent presentation in persons with impaired pain sensation, such as the elderly or diabetics.Paraphimosis in uncircumcised or incompletely circumcised children is a serious and painful condition requiring prompt reduction to prevent possible necrosis of the glans or urinary obstruction.7 8 Beaugé recommends manual code promo undiz 2018 stretching for young males in preference to circumcision as a treatment for non-retractile foreskin because of the preservation of sexual sensation.
This involves compressing the glans and moving the foreskin back to its normal position, perhaps with the aid of a lubricant, cold compression, and local anesthesia as necessary.
Because of extreme pain, patients may require a penile nerve block (.
6 Stretching may be combined with the use of a steroid cream.
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