Paraphimosis

Definition

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

Paraphimosis and related disorders

Generally, paraphimosis is closely related to phimosis: refining the concept, in many patients with non-tight phimosis (a condition in which a partial uncovering of the glans is possible), the foreskin uncovers the glans during erection but, subsequently, the preputial sheet is no longer able to return to the resting position [taken from www.fimosi.com].
In paraphimosis, the preputial ring squeezes the glans, suffocating it: consequently, the likelihood of edema being created in the site is very high. But that's not all, since this condition could cause urinary retention, an event following the compromise of the urethral canal. .
In severe cases, paraphimosis could cause ulcer and, when not treated, venous stasis of the glans penis or even gangrene.
When paraphimosis degenerates, it could favor the occlusion of the genital arteries, therefore ischemic necrosis of the glans: it is an extreme situation, therefore rare although possible [taken from Pediatric surgery. Approach and management of the child with surgical problems By G.B. Paris]

Causes

Researching 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 balanitis, balanoposthitis and postiti can represent the expedient for the manifestation of paraphimosis.

Incidence

Unfortunately, paraphimosis is not rare, quite another: many patients, admitted to the urology department after a physical trauma / surgery, are denied the possibility of returning the foreskin to its resting position (wrapping the glans) after an "erection" .
The subjects most at risk of paraphimosis are the elderly and children, especially those uncircumcised.

Symptoms

For further information: Paraphimosis Symptoms

In the clinical picture derived from paraphimosis, an evident inflammation can often be noted, the causes of which date back to both bacterial infections and genital traumatic events.
The foreskin, strangling the glans, causes a progressive inflammation related to edema; the patient complains of strongly painful sensations (some define the pain as "excruciating and unbearable") not only in 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 sheet. It is absolutely essential to go to a hospital or private clinic as quickly as possible because paraphimosis is a "urological urgency for all patients. effects: as we have analyzed, underestimating the disorder and delaying to consult the doctor are mistakes that could cost the affected patient dearly.
First of all, the person who complains of paraphimosis is advised to carry out some manual practices:

• Squeeze the glans for a few minutes with both hands, compress the foreskin in order to reduce the edema and, at the same time, push progressively on the glans to reach a position of reduction. [adapted from Pediatric surgery. Approach and management of the child with surgical problems By G.B. Paris]
• Dundee technique: try to deflate the edema through the repetition of squeezes on the glans and delicate punctures of the same with a thin needle

It is recommended to contact the specialist (urologist, in general), who will provide for the preputial retraction and the escape of the accumulated edematous fluid. When, despite manual practices, the foreskin fails to cover the glans, surgery is recommended (surgical reduction under local / general anesthesia, surgical circumcision).
Circumcision can be an "excellent practice aimed at prophylaxis of paraphimosis.

Prognosis

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

Summary

Paraphimosis: in short

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Paraphimosis

Description

Male pathological condition: after extrusion of the glans due to erection, the foreskin is no longer able to wrap the barnacle again.

Disorders related to paraphimosis

• phimosis
• constriction of the glans → formation of edema → compromised 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 balanoposthitis

Incidence of paraphimosis

The subjects most at risk of paraphimosis are the elderly and children

Symptom picture of paraphimosis

• Obvious phlogosis;
• Edema;
• "Excruciating and unbearable" pain throughout the body of the penis

Therapeutic strategies for paraphimosis

• Manual Practices and Dundee Technique;
• The urologist retracts the foreskin and between the oedematous fluid escapes;
• Surgical reduction;
• Circumcision

Prognosis

Excellent, when you go to the doctor from the very first symptoms of paraphimosis
Severe outcome when paraphimosis is not treated (gangrene, damage or loss of the extremity of the glans and haemostasis at the level of the balano-preputial sulcus)