Approach to management of paraphimosis

This algorithm provides the approach to reduction of a suspected paraphimosis. Manual reduction is usually successful when the clinician provides adequate pain control with or without methods to reduce preputial (distal foreskin) swelling. In children, procedural sedation provides optimal conditions for successful reduction. This algorithm is intended for use with other UpToDate content on paraphimosis.

OR: operating room.

* In infants, hair or cloth fibers can wind around the penis and cause tourniquet syndrome. In adults, intentionally placed items to prolong an erection include rubber bands or rings. Approach to removal depends upon the constricting foreign body. Refer to UpToDate content on the treatment of hair tourniquet and other narrow constricting bands.

¶ For patients with unsuccessful manual reduction despite adequate pain control and/or procedural sedation. Additional reduction procedures include manual reduction under general anesthesia, foreskin retraction with forceps (blunt Babcock or sharp Adson forceps), dorsal slit reduction, or circumcision.

Graphic 145543 Version 1.0

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Approach to management of paraphimosis