Diagnosis of paraphimosis

In the process of making a diagnosis, it is important for a doctor to talk to the patient first. In the course of this conversation, the physician usually finds the first indications of paraphimosis, such as a slight foreskin tightness or phimosis. Often the patient describes that an erection (whether masturbation or sexual intercourse) has led to the development of this clinical picture. The doctor’s preliminary diagnosis after this conversation is supported by the physical examination, i.e. the inspection of the penis. The paraphimosis can be recognized by the swollen glans and the swollen foreskin, which has been wrapped around the shaft of the penis as a lacing ring, and is a gaze diagnosis.

Therapy of paraphimosis

Reduction, i.e. pushing the foreskin back over the glans, is therapeutically essential. In addition, the reduction should be performed as quickly as possible, otherwise the glans and foreskin may die. There are several ways of performing a reduction.

On the one hand, reduction can be carried out conservatively, i.e. non-surgically, and on the other hand, it can be reduced surgically. First, however, an attempt should be made to cancel the paraphimosis conservatively. Under no circumstances should one attempt to permanently remove the paraphimosis without medical help.

If an attempt by the patient himself was unsuccessful, a urologist should be consulted.Cooling measures on the way to the doctor can help. This procedure is very painful, which is why at least one local anesthetic is administered to numb the nerves supplying the penis. In this conservative, manual reduction, the glans is pressed down while simultaneously pulling the foreskin forward.

To facilitate the sliding back of the glans, the glans is usually greased a little beforehand, with Vaseline for example, and the edema is pricked. This means that a fine cannula is used to try to press out the water retention very carefully. If a manual reduction is not successful after a few short-term attempts, the paraphimosis must be treated surgically.

Every paraphimosis is an emergency, because the vitality of the penis components foreskin and glans is acutely threatened. The longer a paraphimosis remains untreated, the higher the risk of irreversible damage to the structures involved. Surgery becomes necessary if the manual attempt at repositioning has been unsuccessful.

During this surgical procedure, the foreskin, which has become a lacing ring, is incised so that blood can flow again. If required by the patient or his relatives, circumcision can be performed in the same operation to prevent a recurrence of paraphimosis. Even after a successful manual repositioning attempt, the patient or, in the case of a child, the relatives should consult with a urologist as to whether circumcision would not be advisable on a permanent basis to prevent further paraphimosis. If the paraphimosis has persisted for too long and the glans and foreskin have died, surgery must always be performed immediately.