Editing Paraphimosis

{{distinguish|paraphimophis}}
{{Infobox medical condition (new)
| name          = Paraphimosis
| synonyms      = 
| image         = Paraphimosis.jpg
| pronounce     = {{IPAc-en|ˌ|p|ær|ə|f|aɪ|ˈ|m|oʊ|s|ᵻ|s}} or {{IPAc-en|ˌ|p|ær|ə|f|ə|ˈ|m|oʊ|s|ᵻ|s}}<ref>''[[OED]]'' 2nd edition, 1989 as {{IPA|/ˌpærəfaɪˈməʊsɪs/}}.</ref><ref>[http://www.merriam-webster.com/dictionary/paraphimosis Entry "paraphimosis"] in ''[http://www.merriam-webster.com/ Merriam-Webster Online Dictionary]''.</ref>
| field         = [[Urology]]
| alt           = 
| caption       = 
| symptoms      = 
| complications = [[Gangrene]] of the glans penis
| onset         = 
| duration      = 
| types         = Physiological, pathological
| causes        = Iatrogenic, handling foreskin improperly
| risks         = [[Phimosis]], uncircumcised
| diagnosis     = 
| differential  = 
| prevention    = Returning foreskin to unretracted position after retraction, foreskin stretching, circumcision
| treatment     = Manual reduction, circumcision
| medication    = 
| prognosis     = 
| frequency     = 0.2% (uncircumcised children)<ref name="Bragg Leslie 2020">{{cite journal | vauthors = Bragg BN, Leslie SW | title = Paraphimosis | date = 2020-07-01 | pmid = 29083645 | url = https://www.ncbi.nlm.nih.gov/books/NBK459233/ | website = NCBI Bookshelf | access-date = 2020-07-16 }}</ref>
| deaths        = 
}}
'''Paraphimosis''' is an uncommon<ref name="emedicine-donohoe"/> medical condition in which the [[foreskin]] of a penis becomes trapped behind the [[glans penis]], and cannot be ''reduced'' (pulled back to its normal flaccid position covering the glans). If this condition persists for several hours or there is any sign of a lack of blood flow, paraphimosis should be treated as a [[medical emergency]], as it can result in [[gangrene]].<ref name="emedicine-donohoe"/><ref name="emedicine-ghory-general"/><ref name="aafp-choe"/>

==Causes==
Paraphimosis is usually caused by medical professionals ([[Iatrogenic injury|iatrogenic]]) or parents who handle the foreskin improperly.<ref name="emedicine-donohoe"/><ref name="aafp-choe"/> The foreskin may be retracted during penile examination, penile cleaning, [[urethral catheterization]], or [[cystoscopy]]; if the foreskin is left retracted for a long period, some of the foreskin tissue may become [[Edematous|oedematous]] (swollen with fluid), which makes subsequent reduction of the foreskin difficult.{{Citation needed|date=March 2017}}

==Prevention and treatment==
Paraphimosis can be avoided by bringing the foreskin back into its normal, forward, non-retracted position after retraction is no longer necessary (for instance, after cleaning the [[glans penis]] or placing a [[Foley catheter]]). [[Phimosis]] (both pathologic and normal childhood physiologic forms) is a risk factor for paraphimosis;<ref name="emedicine-ghory-general">{{cite web | vauthors = Ghory HZ, Sharma R |title=Phimosis and Paraphimosis |url=http://emedicine.medscape.com/article/777539-overview |date=April 28, 2010 |publisher=eMedicine |quote=Patients with phimosis, both physiologic and pathologic, are at risk for developing paraphimosis  when the foreskin is forcibly retracted past the glans and/or the patient or caretaker forgets to replace the foreskin after retraction.}}</ref> ''physiologic'' phimosis resolves naturally as a child matures, but it may be advisable to treat ''pathologic'' phimosis via long-term stretching or elective surgical techniques (such as [[preputioplasty]] to loosen the preputial orifice or [[circumcision]] to amputate the foreskin tissue partially or completely).{{Citation needed|date=May 2010}}

The foreskin responds to the application of [[Tension (physics)|tension]] to cause expansion by creating new skin cells though the process of [[mitosis]]. The [[tissue expansion]] is permanent. Non-surgical stretching of the foreskin may be used to widen a narrow, non-retractable foreskin.<ref name="Dunn">{{cite journal | vauthors = Dunn HP | title = Non-surgical management of phimosis | journal = The Australian and New Zealand Journal of Surgery | volume = 59 | issue = 12 | pages = 963 | date = December 1989 | pmid = 2597103 | pmc =  | doi = 10.1111/j.1445-2197.1989.tb07640.x }}</ref> Stretching may be combined with the use of a [[corticosteroid]] cream.<ref>{{cite journal | vauthors = Zampieri N, Corroppolo M, Camoglio FS, Giacomello L, Ottolenghi A | title = Phimosis: stretching methods with or without application of topical steroids? | journal = The Journal of Pediatrics | volume = 147 | issue = 5 | pages = 705–6 | date = November 2005 | pmid = 16291369 | pmc =  | doi = 10.1016/j.jpeds.2005.07.017 | s2cid = 29301071 }}</ref><ref>{{cite journal | vauthors = Ghysel C, Vander Eeckt K, Bogaert GA | title = Long-term efficiency of skin stretching and a topical corticoid cream application for unretractable foreskin and phimosis in prepubertal boys | journal = Urologia Internationalis | volume = 82 | issue = 1 | pages = 81–8 | date = 2009 | pmid = 19172103 | pmc =  | doi = 10.1159/000176031 | s2cid = 5287988 }}</ref> Beaugé recommends manual stretching for young males in preference to circumcision as a treatment for non-retractile foreskin because of the preservation of sexual sensation.<ref name="beauge">{{cite journal | vauthors=Beaugé M | title=The causes of adolescent phimosis | journal=Br J Sex Med | date=1997 | volume= | issue=September–October | pages=26 | doi= | pmid= | pmc= }}</ref>

Paraphimosis can often be effectively treated by manual manipulation of the swollen foreskin tissue. This involves compressing the glans penis and moving the foreskin back to its normal position, perhaps with the aid of a lubricant, cold compression, and local anesthesia as necessary. If this fails, the tight edematous band of tissue can be relieved surgically with a [[dorsal slit]],<ref name="emedicine-donohoe">{{cite web | vauthors = Donohoe JM, Burnette JO, Brown JA |title=Paraphimosis |url=http://emedicine.medscape.com/article/442883-overview |date=October 7, 2009 |publisher=eMedicine |quote=Patients with severe paraphimosis that proves refractory to conservative therapy will require a bedside emergency dorsal slit procedure to save the penis. A formal circumcision can be performed in the operating room at a later date... At a later date, a formal circumcision can be performed as an outpatient procedure.}}</ref><ref name="aafp-choe">{{cite journal | vauthors = Choe JM | title = Paraphimosis: current treatment options | journal = American Family Physician | volume = 62 | issue = 12 | pages = 2623–6, 2628 | date = December 2000 | pmid = 11142469 | url = http://www.aafp.org/afp/20001215/2623.html | quote = If a severely constricting band of tissue precludes all forms of conservative or minimally invasive therapy, an emergency dorsal slit should be performed. This procedure should be performed with the use of a local anesthetic by a physician experienced with the technique... Circumcision, a definitive therapy, should be performed at a later date to prevent recurrent episodes, regardless of the method of reduction used... Granulated sugar has shown to be effective in the treatment of paraphimosis, based on the principle of fluid transfer occurring through osmotic gradient. Granulated sugar is generously spread on the surface of the edematous prepuce and glans. The hypotonic fluid from the edematous prepuce travels down the osmotic gradient into the sugar, reducing the swelling and allowing for manual reduction. }}</ref> or a circumcision.<ref>{{cite web | vauthors = Santucci RA, Terlecki RP |title=Phimosis, Adult Circumcision, and Buried Penis |url=http://emedicine.medscape.com/article/442617-overview |date=April 15, 2009 |publisher=eMedicine |quote=Reduction of the foreskin under sedation is almost always possible. However, in some situations, a dorsal slit or circumcision is required}}</ref><ref name="dundee"/><ref>{{cite book |title=Surgical care at the district hospital |publisher=World Health Organization |year=2003 |isbn=92-4-154575-5 |pages=9–10}}</ref><ref>{{cite book |title=First Aid for the Emergency Medicine Clerkship | vauthors = Stead LG, Stead SW, Kaufman MS  |isbn=0-07-144873-X |year=2006 |pages=231| publisher = Mcgraw-hill }}</ref><ref>{{cite book |title=Pediatric Urology for the Primary Care Provider | vauthors = Zderic S, Platcher N, Kirk J |isbn=978-1-55642-785-5 |year=2008 |pages=80| publisher = SLACK Incorporated }}</ref>  An alternative method, the Dundee technique, entails placing multiple punctures in the swollen foreskin with a fine needle, and then expressing the edema fluid by manual pressure.<ref name="dundee"><!-- backup source in case the following link dies: http://www.cirp.org/library/treatment/phimosis/reynard1/ -->to be 5 {{cite journal | vauthors = Reynard JM, Barua JM | title = Reduction of paraphimosis the simple way - the Dundee technique | journal = BJU International | volume = 83 | issue = 7 | pages = 859–60 | date = May 1999 | pmid = 10368214 | pmc =  | doi = 10.1046/j.1464-410x.1999.00119.x | s2cid = 5133709 | url = http://www3.interscience.wiley.com/journal/119091336/abstract | url-status = dead | archive-url = https://archive.today/20130105065642/http://www3.interscience.wiley.com/journal/119091336/abstract | archive-date = 2013-01-05 | url-access = subscription }}</ref> According to Ghory and Sharma, treatment by circumcision may be elected as "a last resort, to be performed by a [[urologist]]".<ref name="emedicine-ghory-treatment">{{cite web | vauthors = Ghory HZ, Sharma R |title=Phimosis and Paraphimosis |url=http://emedicine.medscape.com/article/777539-treatment |date=April 28, 2010 |publisher=eMedicine}}</ref> Other experts recommend delaying elective circumcision until after paraphimosis has been resolved.<ref name="emedicine-donohoe"/> A non-invasive method is the application of granulated sugar to induce transfer of the hypotonic fluid out of the edematous tissue towards the wet sugar via osmotic gradient, to reduce swelling and enabling manual reduction. <ref name="aafp-choe"></ref>

== References ==
{{reflist}}

== External links ==
{{Medical resources
|  DiseasesDB      = 9613
|  ICD10           = {{ICD10|N|47|2}}
|  ICD9            = {{ICD9|605}}
|  ICDO            =
|  OMIM            =
|  MedlinePlus     = 001281
|  eMedicineSubj   =
|  eMedicineTopic  =
|  MeshID          =
}}
{{Male diseases of the pelvis and genitals}}

[[Category:Medical emergencies]]
[[Category:Penis disorders]]