Paraphimosis

Scope

This guideline covers Paraphimosis in both adults and children.

Paraphimosis occurs when a tight prepuce is retracted and is then unable to be replaced as the glans swells.

Always check there is no encircling foreign body constricting venous return, such as a ring, rubber band or hair.

If simple methods to resolve it fail (see management) then refer urgently to a urologist.

Risk factors

A tight prepuce causes swelling when it is retracted. This may occur after failing to pull the foreskin forward to its natural position after cleaning or catheterisation
Scarring of the prepuce after repeated forcible retraction in an attempt to 'cure' a physiological phimosis
Vigorous sexual activity
Chronic balanoposthitis (typically in patients with diabetes)
Penile piercing can lead to paraphimosis but the most common cause is urinary catheterisation when, after inserting the catheter, there is failure to replace the foreskin over the glans after the procedure

Presentation

Failure to remove the constricting band of paraphimosis will result in necrosis of the glans.

Gentle compression with a saline-soaked swab followed by reduction of the prepuce over the glans is usually successful
Gradual manual reduction of the prepuce over the glans is done by placing both index fingers on the dorsal border of the penis and thumbs on the glans. The glans is pushed back while the index fingers pull the prepuce back over the glans
This technique can be facilitated by trying to achieve reduction of swelling first. Ice may be applied. Manual compression is achieved by asking the patient to squeeze the glans for anything from 5 to 30 minutes. Osmotic reduction involves application of a swab soaked in 50% dextrose to the swollen area for an hour
If simple measures fail refer urgently to urology

Urgent urological referral is recommended for paraphimosis, especially when associated with a permanent urethral catheter
Manual reduction of a paraphimosis is usually possible but patients should, subsequently, be referred for consideration of circumcision

e-Referral Service Selection:

e-Referral Service Selection

This guideline has been signed off by the Western Locality on behalf of NHS Devon CCG.

Publication date: May 2020

Last updated: 21-05-2020