Paraphimosis - an acute condition in which the infringement of the head of the penis occurs in the foreskin, while the head itself cannot 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 stagnation, and the skin becomes bluish tint. The foreskin swells up strongly and resembles a bolster (see fig. 1). For external similarity in the common people such a condition is called the Spanish collar or noose.
Fig. 1 - Paraphimosis.
The difference between paraphimosis and phimosis
Paraphimosis is one of the complications of phimosis , which is why there is practically no difference between the diseases. Paraphimosis develops with II or III degree of phimosis and can never occur with its extreme degree, since in this case exposure of the head is impossible.
Fig. 2 - The difference between phimosis and paraphimosis.
In some cases, the infringement happens without a total disruption of the blood supply, but the clamping of the urethral canal always happens. Especially often this situation is observed in children.
Complications of paraphimosis
Paraphimosis is an acute complication that requires prompt, qualified treatment from a urologist or surgeon. If help is not provided in a timely manner, the disease will quickly progress, and will lead to necrotization and gangrene of the glans penis. The death of the head can cause not only disability, but also septic complications that are dangerous to the life of the victim.
The overlapping of the urethral canal entails the overstretching of the bladder accumulated urine, and can lead to its rupture, the development of peritonitis and even death. It is because of the serious risks to life that this condition requires immediate treatment.
What causes paraphimosis?
There are various reasons for paraphimosis:
- Running Phimosis If a sick man has phimosis of varying degrees, but the correction of this condition is not made, over time the severity of the disease increases. During erection, with complete retraction or removal of the foreskin beyond the area of the coronary sulcus, the head of the penis is clamped. This condition is called paraphimosis. As a rule, with paraphimosis, pain increases gradually, in proportion to the edema 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 gives purulent-inflammatory complications much more often due to the presence of infection in the region of the external genital organs.
- Improper exposure of the head of the penis of the child. In a boy up to 2 years old, the so-called physiological phimosis can be observed, which by two years should pass by itself. In some cases, the separation of the inner sheet of the foreskin from the head of the penis occurs in a later period - up to 6 years. Phimosis and paraphimosis in children occurs when the head of the child’s penis opens with the use of physical force, which leads to microtrauma of the foreskin.
- Phimosis II and III degree in boys.
- Often, paraphimosis in childhood can begin during intimate hygiene, and in adolescence as a result of masturbation or during sexual intercourse.
- Also, paraphimosis can be a consequence of medical procedures. This paraphimosis is called iatrogenic and most often occurs during catheterization of the urethra and urinary bladder of a man. Iatrogenic form of paraphimosis appears during cystoscopy.
The clinical picture and symptoms of the disease
Paraphimosis is manifested characteristic and pronounced clinic. It is not difficult to recognize paraphimosis in both an adult man and a child, the following symptoms indicate:
- Acute sharp 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 coronary sulcus.
- Ischemia. The distal or terminal part of the penis acquires a dark and bluish color, which indicates a significant stagnation of blood in this area and the presence of oxygen starvation of tissues.
- Forced position of the victim. The patient is trying to take the most benign position of the body to reduce pain. In case of paraphimosis, a person is in a position with his legs wide apart and a corpus strongly inclined forward.
- Difficulty or lack of urination. In 90% of cases, urination is completely absent and leads to an overstretching of the walls of the bladder.
The presence of the above symptoms allows the urologist to immediately make a diagnosis and carry out procedures aimed at correcting the emergency.
Paraphimosis is an emergency requiring immediate medical attention. Before seeking qualified assistance, an ice pack or cold compress is applied to the affected person to help slow the necrosis of ischemic tissues. You can also apply a dressing 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.
It consists in manual bimanual reposition of the glans penis in the ring of the foreskin. In children, this procedure is performed under anesthesia, in adults under local anesthesia. Anesthesia is mandatory due to the threat of pain shock. Before starting a bimanual reduction, the head must be lubricated with vaseline oil or glycerin. In advanced cases, puncture the edematous foreskin first, which reduces the degree of infringement.
After setting and stopping paraphimosis, the patient is prescribed therapeutic baths with antiseptic solutions and anti-inflammatory drugs. For men, it is also recommended to observe sexual rest for several weeks.
Operative method can be carried out longitudinal dissection of the foreskin. Such an operation is called incision. It leads to deformation and reduced function of the foreskin. On the restoration of penile tissue takes an average of six weeks. After a planned operation is carried out on the circular excision of the foreskin - circumcision or circumcision (see "Pros and cons of circumcision" ). For the prevention of inflammatory complications in the postoperative period, a course of treatment with antibacterial drugs is prescribed.
Conservative treatment of paraphimosis can not give guarantees and is not a complete treatment of the disease. It allows to stop the acute complication of phimosis, however, paraphimosis can recur, and more than once. The only effective treatment, both phimosis and paraphimosis, is surgery - circumcisio, which completely removes the pathologically changed foreskin.