- Patients with hair tourniquet or other constricting bands around the penis have physical findings that are very similar to paraphimosis.
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- Patients with glans penis ischemia with necrosis require emergency consultation with a urologist or surgeon with similar expertise and preparation for invasive reduction utilizing procedural sedation in the ED or general anesthesia in the OR.
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- All patients require an appropriate level of pain control and may require procedural sedation according to the severity of the presentation.
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- Methods to reduce swelling require a significant amount of time (eg, 30 to 60 minutes) to have an important impact on foreskin and glans penis swelling and should not be used when penile necrosis is evident, urgent reduction is required, and/or reduction under general anesthesia or procedural sedation is planned.
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- The compression time during a successful manual reduction of a paraphimosis often exceeds 5 minutes if adjuncts such as ice, compression bandages, or osmotic agents are not used.
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