Ver el código de «Paraphimosis»

==Background==
*Foreskin trapped behind glans
*Urologic emergency
**May result in glans necrosis if not reduced due to venous engorgement causing arterial compromise

==Clinical Features==
*Pain
*Erythema
*Swelling distal to constricting ring of foreskin

==Differential Diagnosis==
{{Nontrauma penile DDX}}
{{Penile Trauma DDX}}

==Evaluation==
*Typically a clinical diagnosis

==Management==
*Reduction
**Perform as soon as possible
**Consider [[Nerve Block: Penile|penile block]], local anesthetic cream (EMLA) or procedural sedation 
**Use bag of ice (3min intervals) or manual compression before attempting reduction
***Consider granulated sugar (as an osmotic agent)
***Wrap glans with 2x2-in. elastic bandage for 5min 
**Use thumbs to push the glans into the foreskin while index fingers pull foreskin back into normal position
*If fails obtain emergent urology consult and/or perform the following:
**Use 22-25ga needle to make multiple punctures (3-5mm deep) in foreskin (expresses glans edema fluid) and then perform compression
**Inject hyaluronidase into the swollen foreskin to decrease edema
**Can also use several evenly spaced, babcock (noncrushing) clamps around foreskin, followed by gentle traction to pull phimotic ring over the glans
**[[Dorsal Slit (Penis)|Dorsal Slit]] indicated if evidence of impaired perfusion and urologist unavailable

==Disposition==
*Refer all cases to urology to determine need for circumcision

==See Also==
*[[Dorsal Slit (Penis)]]
*[[Phimosis]]

==References==
<references/>


[[Category:Urology]]
[[Category:Pediatrics]]