Nephrology for the Family Physician - O.I. Bakaliuk 2003

Emergency Uro-Nephrology
Phimosis and Paraphimosis

Phimosis is a pathological narrowing of the foreskin opening that prevents it from retracting over the glans Penis. In children, phimosis is a physiological condition that typically resolves spontaneously by the age of 5–6 years. In adults, phimosis is usually acquired and caused by penile diseases. In pediatric patients, it often manifests due to smegma infection and The Development of balanoposthitis, with ballooning of the preputial sac during urination being its characteristic sign.

The Diagnosis of phimosis is based on observing the act of urination.

Physiological phimosis in children aged 3–5 years does not require Treatment; periodic proximal retraction of the foreskin is recommended, along with washing the glans penis with a furatsilin solution (1 : 5000), applying sterile petroleum jelly, administering sit baths with a 0.1% potassium permanganate solution, and subsequently returning the foreskin to its original position.

Surgical treatment is indicated in cases of true phimosis.

Paraphimosis is a condition characterized by the entrapment of the glans penis by the inner layer of the foreskin when it is forcibly retracted proximally past the corona glandis. The inability of the foreskin to return spontaneously to its initial position due to edema of the glans causes severe pain and difficulty urinating, up to Acute Urinary Retention. The increasing edema leads to trophic disorders, Necrosis of the foreskin layers, and the corpora cavernosa of the penis.

Diagnosis is straightforward and based on physical examination findings.

Treatment should be administered as early as possible. In the Cytology/cytology/16.html">Early stages of paraphimosis (when transporting the patient to a specialized department is not feasible), manual reduction of the glans penis is employed.

Technique of manual reduction of the glans penis in paraphimosis. Under intravenous anesthesia, after lubricating the glans penis with sterile petroleum jelly, the middle and index fingers of both hands firmly grasp the penis just below the constricting ring. At the same time, the thumbs are used to push the glans penis (Fig. 106) through the constricting ring while simultaneously pulling the foreskin back over it.

Another method for reducing the glans penis exists. The penis is grasped with the left hand below the constricting ring, and an attempt is made to pull the foreskin over the glans, while the index and thumb of the right hand simultaneously attempt to guide the glans past the constricting ring (Fig. 107).

If manual reduction fails using these Methods, a longitudinal incision along the dorsal surface should be performed to transect all layers of the constricting ring. A dressing with an antiseptic solution is applied to the wound. Subsequent treatment is managed as for balanoposthitis (cleansing the glans penis and foreskin with a furatsilin solution (1:5000), 0.1% potassium permanganate solution, 0.5–1% silver nitrate solution; applying erythromycin ointment, synthomycin emulsion, Lugol's solution in glycerin, aqueous methylene blue solution, or 10% sodium borate in glycerin to the Skin of the glans; and administering soda sit baths).

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Fig. 106. Technique of manual reduction of the glans penis in paraphimosis.

Fig. 107. Technique of manual reduction of the glans penis in paraphimosis.