Paraphimosis: Definition, pathophysiology, and clinical features
- 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
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Paraphimosis occurs when the foreskin in the uncircumcised or partially circumcised male is retracted behind the glans penis, develops venous and lymphatic congestion, and cannot be returned to its normal position (picture 1). This urologic emergency impedes blood flow to the glans penis with potential for permanent damage and gangrene.
In infants and young children, paraphimosis usually results from self manipulation by the child or inappropriate retraction of the foreskin by the caretaker in misguided attempts at cleaning. In the sexually active adolescent or adult male, intercourse is a potential precipitant. Iatrogenic paraphimosis follows cystoscopy or bladder catheterization if the foreskin is not reduced back over the glans penis by the medical provider.
Paraphimosis reduction is usually accomplished with pain control, local measures to reduce edema, and manual or minimally invasive manipulation. Emergent urologic consultation is indicated in the minority of patients in whom minimally invasive reduction fails or in patients with prolonged paraphimosis complicated by glans penis necrosis or infection.
This review discusses the anatomy, pathophysiology, and clinical features of paraphimosis. The reduction of paraphimosis is discussed separately. (See "Paraphimosis reduction".)
The terms paraphimosis and phimosis are often confused:
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- Predisposing factors
- CLINICAL FEATURES
- Physical findings
- DIFFERENTIAL DIAGNOSIS
- Tourniquet syndrome
- Insect bites
- Generalized edematous state
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS