Paraphimosis


Paraphimosis

Description, Causes and Risk Factors:

Paraphimosis is an uncommon condition in which the foreskin, once pulled back behind the glans penis, cannot be brought down to its original position, thus constituting one of the few urologic emergencies encountered in general practice. Like phimosis, paraphimosis occurs only in uncircumcised or partially circumcised males.

Paraphimosis results when the foreskin (sheath) is either retracted behind the glans and becomes strictured, or becomes folded (rolled). This constriction can cause blood flow from the penis to be blocked or compromised. When this happens, swelling and inflammation of the glans penis, foreskin (sheath), or both, result. The increased size due to constriction and swelling then prevents the penis from being returned to its natural position within the sheath.

Paraphimosis can be a result of phimosis (inability to retract the prepuce over the glans penis), injury (trauma), infection, or congenital issues such as an abnormally shortened prepuce or an abnormally long penis. There have been reports of paraphimosis occurring after severe dehydration and/or starvation but this has not been confirmed within the scientific community.

Other causes that can lead to paraphimosis are:

    Poor hygiene.

  • Chemical irritants (soaps).

  • Conditions that result in edema (swelling) such as CHF, or nephrosis.

  • Bacterial infections (primarily anaerobic infections).

  • Obesity.

  • Diabetes.

  • Paraphimosis can be a true emergency. If left untreated, the impaired lack of blood flow to the glans can result in urinary retention, infection, and necrosis. It is important to seek help from a veterinarian as soon as possible. Prognosis is favorable with prompt treatment.

When paraphimosis is suspected, immediately obtain a Urology consult for proper evaluation and diagnosis. Prompt attention and treatment of this emergency should lead to a favorable outcome.

Symptoms:

Clinical signs:

    Penis stuck outside of the preputial cavity (sheath). Swelling and balanitis may also be present.

  • Band of retracted skin behind the head of penis, may also be swollen and tight.

  • Rat frantically licks the penis.

  • Rat showing signs of sensitivity and pain when the area is examined or touched.

  • Redness and later darkening of tissue.

  • Usually has difficulty urinating.

Diagnosis:

Care should be taken to take a full health history and perform a full examination. Visual and manual examination of the penis will show a penis that is enlarged and trapped outside of the sheath. The penis may present as a reddened, round ball of flesh.

Pharaphimosis should not be confused with priapism (an erection that doesn't subside) or phimosis (constricted foreskin that can trap the penis inside and prevent it from being able to emerge from the sheath.) If the condition returns steps should be taken to determine if there is an underlying problem.

Treatment:

Treatment options include:

Noninvasive treatment methods: Very gently retract sheath, gently cleanse with warm water and mild soap to remove any secretions that may have built up, rinse gently, and pat dry. Apply a lubricant (e.g. olive oil, canola oil, vegetable oil, peanut oil) to the penis to help with gentle manual reinsertion and prevent tissue from drying out. The use of an antibiotic ointment (e.g. Neosporin or Polysporin) may be applied to help control infection if present.

Mildly invasive treatment: Puncture technique (under anesthesia) by hypodermic needle via several puncture sites to the edematous prepuce for evacuation of trapped fluid.

Invasive treatment: In extreme or reoccurring cases it may be necessary to perform a surgical dorsal slit incision, under anesthesia, to enlarge the preputial orifice.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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