Paraphimosis

Paraphimosis is retracted foreskin in an uncircumcised male that cannot return to normal position.

Predisposing factors

1. Phimosis- main
2. Trauma to the penis- piercings
3. After procedures- catheterisation
4. Sexual activity
5. Others- P.falciparum infection, failure to replace skin after cleaning or urination

Clinical presentation

• Penile pain, penile swelling
• Oedema of glans, tenderness but shaft is unaffected
• Constricting band of tissue at the coronal sulcus
• Discolored glans

Management

• Analgesia
• Manual reduction. If it fails, refer to a urologist

Specialty consultation in;

1. Penile necrosis
2. Urinary obstruction
3. If reduction unsuccessful

Differential diagnosis

1. Angioedema
2. Torniquet syndrome- infants
3. Bites from insects
4. Balanoposthitis
5. Systemic edematous states

Complications

Delay in diagnosis and management leads to;

1. Local and penile necrosis
2. Infarction and gangrene of the glans leading to auto amputation