Paraphimosis

Disease Description (Causes and Symptoms)

• Definition: Paraphimosis is a condition in which the foreskin is pulled behind the glans and cannot return to its original position, causing constriction of the glans and foreskin.
• Pathophysiology: When the foreskin is fixed behind the glans, venous and lymphatic drainage is blocked, causing swelling and congestion of the glans and foreskin. If it progresses, arterial blood flow may also be impaired, potentially leading to necrosis.
• Causes/Risk factors: A narrow foreskin ring (phimosis), excessive retraction of the foreskin, balanitis or posthitis, after urethral catheter insertion or procedures, trauma after masturbation or sexual activity, and inadequate hygiene or improper treatment in children.
• Main symptoms: Severe pain, swelling and congestion of the glans and foreskin, changes in glans color (pink → dark red → black), difficulty urinating or urinary retention (especially in children), and abnormal sensation.

Treatment Methods

• Emergency principles: Early decompression (reducing swelling) and reduction of the foreskin (restoring it by pulling it forward over the glans). The risk of necrosis increases if treatment is delayed.
• Nonsurgical emergency treatment (attempted first)
  • Pain relief and anesthesia: Local sedation, epidural or dorsal penile nerve block (at a hospital), or administration of analgesics/sedatives.
  • Compression method: Apply continuous manual compression for 5–10 minutes to reduce swelling, then pull the foreskin forward for reduction.
  • Elastic bandage/compression wrapping: Compress the entire penis to reduce swelling, then attempt reduction (check the condition intermittently).
  • Apply a cold compress/ice pack intermittently to relieve swelling.
  • Osmotic therapy: A method of reducing fluid in swollen tissue using sugar or a hypertonic solution (used in the field and in some emergency rooms).
  • Multiple puncture method: Puncture the swollen areas of the foreskin in multiple places with a needle to drain fluid, reduce swelling, and then attempt reduction.
• Surgical treatment (if nonsurgical methods fail or necrosis is suspected)
  • A dorsal slit under local anesthesia or circumcision (for definitive treatment).
  • If necrosis or infection is present, removal of affected tissue and appropriate treatment.
• Medications/antibiotics: Consider prophylactic antibiotics when there are signs of infection or before and after surgery.
• Hospitalization/observation: Emergency hospitalization and preparation for surgery are needed in cases of risk of recurrence, suspected necrosis, children, or accompanying urinary retention.
• Precautions/self-care: Never forcibly pull the foreskin backward (risk of worsening the condition); monitor for infection, bleeding, and urination status after the procedure; return to the hospital immediately if pain persists or the glans changes color.

Checklist Before an Outpatient Visit (Including Example Questions)

• Items and records to prepare
  • Time of symptom onset and progression (hours/days)
  • Treatments attempted (self-reduction attempts, ice compresses, compression, etc.)
  • Urination status (whether urine is passing, feeling of residual urine, or complete urinary retention)
  • Current color of the glans and foreskin (bring photographs if possible)
  • Degree of pain (on a scale of 0–10) and whether there is any loss of sensation
  • Whether a catheter is inserted and its type
  • Current medications (including anticoagulants) and allergy records
  • History of previous circumcision or penile surgery, or previous foreskin problems
• Examples of questions to ask first at the outpatient visit (prepare in advance)
  • When did the symptoms begin?
  • Can you urinate? If no urine is coming out, when did that start?
  • Have you tried to return the foreskin to its original position yourself?
  • Have you recently undergone any penis-related procedures (catheter insertion, examination, sexual activity, etc.)?
  • Are you currently taking any medications, especially anticoagulants?

General Examples of Questions to Ask the Doctor

• Is emergency treatment (nonsurgical reduction) possible in my current condition?
• What are the expected pain and recovery time for this treatment?
• Are antibiotics or pain medication necessary? What are the side effects?
• If surgery (dorsal slit or circumcision) is necessary, what are the advantages and disadvantages and what is the recovery process?
• What lifestyle changes should I make to prevent recurrence?

Examples of Condition-Specific Questions

• The glans is turning black or appears to have completely lost sensation. Is necrosis suspected? Is immediate surgery necessary?
• A urethral catheter is currently inserted. Does it need to be removed, and can it be reinserted after removal?