Version June 2024
| 1. Remove any foreign bodies or constricting bands. |
| 2. Inspect the penis for signs of glans penis necrosis (blue/black color and firmness to palpation). |
| 3. If necrosis or urinary obstruction is present, emergently consult urology and prepare for immediate reduction utilizing procedural sedation in the ED or general anesthesia in the OR. |
| 4. If glans penis necrosis is not present (glans penis is pink and soft), provide pain control (eg, topical or infiltrated local anesthetic) and proceed with manual reduction: |
| a. Apply methods to reduce swelling (ice, compression bandages, and/or osmotic agents). |
| b. Ensure efficacy of chosen method of pain control. |
| c. Perform manual reduction by providing manual circumferential compression for several minutes followed by manual reduction. |
| 5. If paraphimosis is still not reduced, advance to a dorsal slit procedure (consult an urologist or surgeon with similar expertise although a knowledgeable physician may perform this procedure if specialty care is not available and emergency reduction is required). Regional anesthesia with a dorsal penile block and, in young children and otherwise uncooperative patients, procedural sedation are typically needed for adequate analgesia. |
| 6. Alternative invasive procedures include (refer to UpToDate topics on treatment of paraphimosis): |
| a. Multiple puncture of the foreskin with a 25 gauge or smaller needle after ensuring appropriate pain control with local or parenteral medications followed by repeated manual reduction. |
| b. Reduction after applying Adson or Babcock forceps to the swollen foreskin. |
| c. Needle aspiration of the glans penis. |
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
