Paraphimosis
Paraphimosis is the compression of the head of the penis by a ring of foreskin. It develops rapidly and needs urgent medical help.
Why does paraphimosis occur?
The main factor contributing to the development of the disease is congenital or acquired phimosis.
Phimosis is a pathology in which there is no independent division of the leaves of the foreskin at the age of 3-7 years. There are 4 degrees of phimosis. Pinching more often occurs during the second and/or third degree, extremely rarely - during the first, and almost never - during the most pronounced fourth.
The direct cause of paraphimosis is an attempt to fully retract (displace) the narrowed ring of preputial tissue behind the head of the penis.
Paraphimosis is most often diagnosed in children and adolescents, but it also occurs in adult men.
In children, paraphimosis develops during hygienic procedures, when parents actively try to move the foreskin ring. In adult patients, it can occur during sexual intercourse. One of the factors of the disease is a bridle that is too short and/or not elastic enough.
In clinical practice, there is a concept of iatrogenic paraphimosis. It is the result of a medical worker's attempt to forcefully open the head of the patient's penis during examination, treatment or diagnostic procedures (when inserting a catheter or cystoscope).
One of the possible causes of paraphimosis is the presence of an ulcer on the preputial tissue in syphilis. Pathology can also develop due to manifestations of allergies in the area of the external genitalia of a man. There is a possibility of pinching from the piercing.
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Symptoms of the disease
If the folds forming the foreskin are in a displaced position for a long time, local blood circulation and lymph outflow are disturbed. This contributes to the development of swelling, and the ring of the foreskin forms a dense roller, which differs in color from healthy tissues. When swelling increases, self-retraction of the head becomes absolutely impossible. No changes are observed in the region of the trunk behind the coronal furrow.
Main clinical manifestations:
- intense pain syndrome that increases during palpation;
- the appearance of a bluish shade of the head of the penis;
- rapid increase in swelling.
In children, one of the symptoms may be difficulty urinating or acute urinary retention.
A patient with paraphimosis is characterized by a posture with a body bent forward and legs apart.
Treatment of paraphimosis
Anamnesis data and the results of a visual examination can be the basis for making a diagnosis. The disease is treated by urologists, andrologists or surgeons.
If timely measures are not taken, there is a risk of developing necrotic changes and ischemic (associated with impaired blood circulation) gangrene. Tissue death may lead to the need for partial amputation of the genital organ (distal part) to save the patient's life.
Help is provided in the conditions of a medical institution. How to treat paraphimosis - the doctor decides in each specific case. The tactics directly depend on the degree of local changes and the general condition of the patient. Self-medication is unacceptable, as it can lead to more serious consequences. Treatment of paraphimosis is usually carried out conservatively, but in some cases surgical intervention is required. If you go to the hospital in time, you can avoid surgery.
Emergency measures for paraphimosis:
- local application of cold;
- applying an elastic bandage;
- lotions with a hypertonic solution of calcium chloride;
- application anesthesia;
- injection of hyaluronidase drug (local).
The purpose of these measures is to reduce swelling and reduce the intensity of the pain syndrome.
After cooling and lubricating the organ with antiseptic and vaseline, the doctor performs bimanual manipulation under local anesthesia (children are given anesthesia). After conservative measures, the patient is shown applications of prednisone and vaseline ointment, as well as baths with a weak solution of potassium permanganate.
In advanced paraphimosis, surgery is the only way out. It involves a longitudinal or circular dissection of tissues that pinch the head. One of the surgical techniques is the puncture of swollen tissues. In the postoperative period, the patient is prescribed prophylactic antibiotics and general therapy. After the inflammation subsides, circumcision is advisable to prevent recurrences.
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