Paraphimosis: Clinical manifestations, diagnosis, and treatment
- Matthew Tews, DO
Matthew Tews, DO
- Associate Professor of Emergency Medicine
- Medical College of Wisconsin
- Jonathan I Singer, MD
Jonathan I Singer, MD
- Section Editor — Pediatric Surgical Emergencies
- Professor of Emergency Medicine and Pediatrics
- Wright State University Boonshoft School of Medicine
- Section Editors
- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr., MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic discusses the clinical features, diagnosis, and treatment of paraphimosis.
Other pathologic conditions of the foreskin (eg, phimosis) and the care of the uncircumcised penis are discussed separately. (See "Care of the uncircumcised penis", section on 'Pathologic conditions' and "Care of the uncircumcised penis" and "Balanitis and balanoposthitis in adults".)
The terms paraphimosis and phimosis are often confused:
●Paraphimosis refers to a retracted foreskin in an uncircumcised or partially circumcised male that cannot be returned to normal position (picture 1).
●Phimosis is defined as a tight foreskin that cannot be retracted to expose the glans penis. In young children, phimosis is normal or physiologic. In older patients, infections such as balanoposthitis or other inflammatory conditions result in scarring and pathologic phimosis that requires urologic referral. (See "Care of the uncircumcised penis", section on 'Physiologic phimosis' and "Care of the uncircumcised penis", section on 'Pathologic phimosis' and "Balanitis and balanoposthitis in adults", section on 'Phimosis'.)
- Porter WM, Bunker CB. The dysfunctional foreskin. Int J STD AIDS 2001; 12:216.
- Reynard JM, Barua JM. Reduction of paraphimosis the simple way - the Dundee technique. BJU Int 1999; 83:859.
- McCollough M, Sharieff GQ. Abdominal surgical emergencies in infants and young children. Emerg Med Clin North Am 2003; 21:909.
- Hollowood AD, Sibley GN. Non-painful paraphimosis causing partial amputation. Br J Urol 1997; 80:958.
- Raman SR, Kate V, Ananthakrishnan N. Coital paraphimosis causing penile necrosis. Emerg Med J 2008; 25:454.
- Gausche M. Genitourinary surgical emergencies. Pediatr Ann 1996; 25:458.
- Barone JG, Fleisher MH. Treatment of paraphimosis using the "puncture" technique. Pediatr Emerg Care 1993; 9:298.
- Williams JC, Morrison PM, Richardson JR. Paraphimosis in elderly men. Am J Emerg Med 1995; 13:351.
- Fariña LA, Alonso MV, Horjales M, Zungri ER. [Contact-derived allergic balanoposthitis and paraphimosis through topical application of celandine juice]. Actas Urol Esp 1999; 23:554.
- Verma S. Coital penile trauma with severe paraphimosis. J Eur Acad Dermatol Venereol 2005; 19:134.
- Berk DR, Lee R. Paraphimosis in a middle-aged adult after intercourse. Am Fam Physician 2004; 69:807.
- Finkelstein JA. "Puncture" technique for treating paraphimosis. Pediatr Emerg Care 1994; 10:127.
- Ramdass MJ, Naraynsingh V, Kuruvilla T, Maharaj D. Case report. Paraphimosis due to erotic dancing. Trop Med Int Health 2000; 5:906.
- Higgins SP. Painful swelling of the prepuce occurring during penile erection. Genitourin Med 1996; 72:426.
- Jones SA, Flynn RJ. An unusual (and somewhat piercing) cause of paraphimosis. Br J Urol 1996; 78:803.
- Hansen RB, Olsen LH, Langkilde NC. Piercing of the glans penis. Scand J Urol Nephrol 1998; 32:219.
- Gozal D. Paraphimosis apparently associated with Plasmodium falciparum infection. Trans R Soc Trop Med Hyg 1991; 85:443.
- Garty BZ, Mimouni M, Varsano I. Penile tourniquet syndrome. Cutis 1983; 31:431.
- Tournel G, Desurmont M, Bécart A, et al. Child barbarity and torture: a case report. Am J Forensic Med Pathol 2006; 27:263.
- Greenspan L. Tourniquet syndrome caused by metallic bands: a new tool for removal. Ann Emerg Med 1982; 11:375.
- Smith GA, Sharma V, Knapp JF, Shields BJ. The summer penile syndrome: seasonal acute hypersensitivity reaction caused by chigger bites on the penis. Pediatr Emerg Care 1998; 14:116.
- Vunda A, Lacroix LE, Schneider F, et al. Videos in clinical medicine. Reduction of paraphimosis in boys. N Engl J Med 2013; 368:e16.
- Dubin J, Davis JE. Penile emergencies. Emerg Med Clin North Am 2011; 29:485.
- Chambers P. Paraphimosis reduction. In: Textbook of Pediatric Emergency Procedures, 2nd ed, King C, Henretig FM (Eds), Lippincott, Williams & Wilkins, Philadelphia 2008. p.904.
- Cahill D, Rane A. Reduction of paraphimosis with granulated sugar. BJU Int 1999; 83:362.
- Choe JM. Paraphimosis: current treatment options. Am Fam Physician 2000; 62:2623.
- Olson C. Emergency treatment of paraphimosis. Can Fam Physician 1998; 44:1253.
- Turner CD, Kim HL, Cromie WJ. Dorsal band traction for reduction of paraphimosis. Urology 1999; 54:917.
- Little B, White M. Treatment options for paraphimosis. Int J Clin Pract 2005; 59:591.
- Houghton GR. The "iced-glove" method of treatment of paraphimosis. Br J Surg 1973; 60:876.
- Pohlman GD, Phillips JM, Wilcox DT. Simple method of paraphimosis reduction revisited: point of technique and review of the literature. J Pediatr Urol 2013; 9:104.
- Ganti SU, Sayegh N, Addonizio JC. Simple method for reduction of paraphimosis. Urology 1985; 25:77.
- Kerwat R, Shandall A, Stephenson B. Reduction of paraphimosis with granulated sugar. Br J Urol 1998; 82:755.
- Anand A, Kapoor S. Mannitol for paraphimosis reduction. Urol Int 2013; 90:106.
- Coutts AG. Treatment of paraphimosis. Br J Surg 1991; 78:252.
- Hamdy FC, Hastie KJ. Treatment for paraphimosis: the 'puncture' technique. Br J Surg 1990; 77:1186.
- Waters TC, Sripathi V. Reduction of paraphimosis. Br J Urol 1990; 66:666.
- Kumar V, Javle P. Modified puncture technique for reduction of paraphymosis. Ann R Coll Surg Engl 2001; 83:126.
- Fuenfer MM, Najmaldin A. Emergency reduction of paraphimosis. Eur J Pediatr Surg 1994; 4:370.
- DeVries CR, Miller AK, Packer MG. Reduction of paraphimosis with hyaluronidase. Urology 1996; 48:464.
- Baigrie RJ. Treatment for paraphimosis. Br J Surg 1991; 78:378.
- Kamat N. Reduction of paraphimosis the simple way--the Dundee technique. BJU Int 1999; 84:890.
- Raveenthiran V. Reduction of paraphimosis: a technique based on pathophysiology. Br J Surg 1996; 83:1247.
- CLINICAL FEATURES
- Physical examination
- DIFFERENTIAL DIAGNOSIS
- Indications for specialty consultation
- Paraphimosis reduction
- - Manual reduction
- Pain control
- Methods to reduce swelling
- - Dorsal slit reduction
- - Other techniques
- - Complications
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS