genitourinary disorders
How To Do Paraphimosis Reduction Without Dorsal Slit
Step by Step Description of Paraphimosis Reduction
Place all equipment within easy reach on a bedside tray. Apply anesthetic jelly to the glans and foreskin and enclose and compress with an occlusive dressing (eg, plastic wrap or gauze) or a cut-off fingertip of a disposable glove. Allow 20 to 30 minutes for the anesthetic to take effect. Remove any foreign bodies from the affected area. Cleanse the region. Swab in concentric circles from the tip of the penis down to its base and several centimeters beyond, using povidone iodine. injections of the foreskin, or retraction of the foreskin using the Babcock clamp method. If needed, also use oral or intravenous Treatment of Pain , sedation, or other anesthesia. Decrease local edema by compressing the glans and foreskin. Grasp the distal penis in the palm of a gloved hand and squeeze snugly for 5 to 10 minutes or more. Alternatively, in an adult, wrap a strip of gauze or elastic bandage around the area, beginning distally and wrapping most tightly distally and less tightly proximally. Be patient; edema decreases gradually. Remove any bandages before doing manual reduction. Push the glans proximally through the phimotic ring. Using both hands, hold the penis securely between the index and middle fingers bilaterally, just proximal to the phimotic ring. Then, with your thumbs, use slow, steady pressure to push the glans proximally through the ring, while milking the foreskin distally to reduce it fully over the glans. Alternatively, in an adult, grasp and apply traction to the shaft of the penis with one hand while using the thumb of the other hand to push the glans through the phimotic ring. A successful reduction will appear as a foreskin reduced over a swollen glans. Additional methods to decrease the edema of the glans and foreskin and facilitate manual reduction include Application of ice: Place water and ice chips into a surgical glove, then remove any air and tie off the glove. Invaginate the thumb of the glove, place the penis into it, and then hold the glove in place and compress for 5 to 10 minutes. To prevent cold injury to the penis, remove the pack after 10 minutes. Circumferential needle punctures of the edematous foreskin: First, anesthetize the penis. Then use a 21- to 27-gauge needle to make multiple punctures (about 10 to 20) in the edematous foreskin, to allow the edema to seep out during manual compression of the area. During compression, use gauze around the foreskin to absorb the seeping fluid and blood. injections into the foreskin: Inject 1 mL (150 U) total in 1 or 2 subcutaneous injections using a tuberculin syringe (avoid intravascular injection, which can cause Anaphylaxis ). The Application of osmotic agents to the foreskin: Sugar and salt are hypertonic agents, which will draw out the hypotonic edema when applied to the glans and foreskin. This process may take hours and should not be used in acute paraphimosis ( Reference ). After doing any of these maneuvers, manually reduce the foreskin as described above. The Babcock clamp method of reduction Place 6 to 8 Babcock (noncrushing) clamps on the outer edge of the phimotic ring, circumferentially and evenly spaced. Grasp the clamps simultaneously and apply slow, distal traction to pull the phimotic ring over the glans. Be careful not to tear the foreskin. 