Paraphimosis in boys and men - causes, symptoms and treatment

Paraphimosis is an acute condition in which the head of the penis is infringed by the foreskin, while the head itself can not return to its original position. The victim experiences sharp and severe pain in the area of ​​infringement. The head of the penis increases in size due to venous stasis, and the skin acquires a bluish tinge. The foreskin strongly swells and resembles a roller( see Figure 1).For the external similarity in the common people, this condition is called a Spanish collar or a striker.

Fig.1 - Paraphimosis.

Parafimosis differs from phimosis

Paraphimosis is one of the complications of phimosis, which is why there are practically no differences in diseases. Paraphimosis develops at grade II or III of phimosis and can never occur at its extreme degree, since in this case, exposure to the head is impossible.

Fig.2 - Difference of phimosis from paraphimosis.

In some cases, the infringement happens without total violation of the blood supply, but the clamping of the urethral canal always occurs. Especially often this situation is observed in children.

Complications of parafymosis

Paraphimosis is an acute complication requiring immediate and qualified treatment from a urologist or surgeon. If help is not provided in a timely manner, the disease will quickly progress, and lead to necrotization and gangrene of the glans penis. Death of the head can cause not only disability, but also a septic complication, which is dangerous for the life of the victim.

Overlapping of the urethral canal leads to overgrowth of the urinary bladder with accumulated urine, and can lead to its rupture, development of peritonitis and even fatal outcome. It is due to the presence of serious risks to life, this condition requires immediate treatment.

What leads to paraphimosis?

There can be different reasons for paraphimosis:

• The phimosis started. If a sick man has a different degree of phimosis, but no correction is made, the severity of the disease grows over time. During erection with complete retraction or retraction of the prepuce beyond the area of ​​the coronary groove, the glans penis is clamped. It is this condition that is called paraphimosis. As a rule, with paraphimosis, the pain grows gradually, in proportion to the swelling of the tissues of the penis and foreskin. Paraphimosis is a formidable complication of both congenital and acquired phimosis. But it is worth noting that paraphimosis with the acquired form of phimosis is much more likely to cause purulent-inflammatory complications, due to the presence of infection in the external genital area.
• Incorrect exposure of the head of the child's penis. A boy under 2 years old can have a so-called physiological phimosis, which by two years must pass by himself. In some cases, separation of the inner leaf of the foreskin from the glans penis occurs and at a later date - up to 6 years. Phimosis and paraphimosis in children occurs if the head of the penis opens with the use of physical force, which leads to microtraumatism of the prepuce.
• Phimosis II and III degree in boys.
• Often, paraphimosis in childhood can begin in the course of intimate hygiene, and in the teenage period as a result of masturbation or sexual intercourse.
• Paraphimosis may also result from medical procedures. Such paraphimosis is called iatrogenic and most often occurs with catheterization of the urethra and bladder of a man. The iatrogenic form of paraphimosis also appears during cystoscopy.

Clinical picture and symptoms of the disease

Paraphimosis manifests itself as a characteristic and pronounced clinic. To recognize paraphimosis, as in an adult male, and in a child is not difficult, the following symptoms testify to it:

• Acute abdominal pain. But in some situations it can grow gradually. In any case, the pain syndrome is pronounced and requires immediate relief. Edema of the tissues of the penis. The foreskin swells and swells in the form of a rounded cushion in the region of the coronal sulcus.
• Ischemia. The distal or terminal part of the penis acquires a dark and cyanotic color, which indicates a significant stagnation of blood in this area and the presence of oxygen starvation of tissues.
• Involuntary position of the victim. The patient tries to take the most sparing position of the body in order to reduce the pain syndrome. With paraphimosis, the person is in a position with widely spaced legs and a strongly tilted forward body.
• Difficulty or absence of urination. In 90% of cases, urination is not complete and leads to overstretching of the walls of the bladder.

Presence of the above symptoms allows the urologist to immediately diagnose and carry out procedures aimed at correcting the emergency.

Treatment of parafymosis

First aid from

Paraphimosis is an emergency that requires immediate medical attention. Before seeking qualified help, an ice pack or cold compress is applied to the victim, which will help slow the necrosis of tissue that has undergone ischemia. You can also apply a bandage with hypertonic solution. Due to the high osmolarity of the solution, the edematous tissues of the foreskin will begin to give up moisture, thereby reducing edema.

Treatment of paraphimosis can be both conservative and operative.

Conservative treatment

It is a manual bimanual gliding of the glans penis into the foreskin ring. In children, this procedure is performed under anesthesia, in adults under local anesthesia. Anesthesia is mandatory, due to the threat of development of pain shock. Before the beginning of bimanual reposition, the head must be lubricated with vaseline oil or glycerin. In advanced cases, first puncture the edematous foreskin, which reduces the degree of infringement.

After correction and relief of paraphimosis, the patient is prescribed therapeutic baths with antiseptic solutions and anti-inflammatory drugs. For men, it is also recommended that sexual dormancy be maintained for several weeks.

Surgical treatment of

The operative method can be used for longitudinal dissection of the prepuce. Such an operation is called an incision. It leads to deformation and a decrease in the function of the foreskin. The restoration of the tissues of the penis takes an average of one and a half months. After a planned operation for circular excision of the foreskin - circumcision or circumcision( see "Pros and cons of circumcision").For the prevention of inflammatory complications in the postoperative period, prescribe course treatment with antibacterial drugs.

Forecast

Conservative treatment of paraphimosis can not give guarantees and is not a full-fledged treatment of the disease. It allows to stop the acute complication of phimosis, but paraphimosis can recur, and repeatedly. The only effective treatment, both phimosis and paraphimosis is the operation - circumcision, which completely allows you to remove the pathologically altered foreskin.

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