• Failure of reduction (success rates depend on
duration of paraphimosis and degree of edema).
• Psychological stress (common; child is restrained for procedure).
• Pain (certain; can be limited somewhat with anesthesia).
• Cold injury.
• Use gauze to grasp the foreskin.
• If swelling is pronounced, try manual compression prior to reduction.
• Timid attempts at reduction in an effort to reduce pain ultimately
result in delayed reduction and increased overall pain.
• If initial attempts are unsuccessful, urgent referral to a urologist
• The child is placed supine.
• Distract the child by having the parent or assistant lean over
the examining table, placing his or her body between the child’s
upper torso and the genital area. This also prevents the child from
getting up and allows the parent or assistant to engage the child
face to face.
• Good lighting is helpful.
• The child is placed supine in the frog-leg position.
• If the child is uncooperative, his legs and pelvis should also
be restrained by an assistant.
A: Normal penis and foreskin. B: Early paraphimosis. C: Late paraphimosis.
• Consider the use of a dorsal penile block in
advance of the procedure, particularly when there is severe edema.
• With gloved hands, grasp the retracted foreskin between the thumb
and the index and middle fingers of each hand.
• Using a gauze pad to grasp the foreskin improves traction.
• Simultaneously pull the foreskin distally as you compress the
glans with both thumbs (Figure 33–2).
• Apply constant and firm pressure.
• When sufficient pressure is applied, the foreskin suddenly reduces,
popping over the glans.
• If the initial attempt is unsuccessful, consider manual decompression
before subsequent attempts.
• Place your hand around the distal foreskin and glans and apply
constant circumferential pressure for approximately 5 minutes.
• Then, attempt reduction again as described above.
• Alternatively, you can apply an ice-water slurry (sealed in either
a specimen collection bag or a tied-off glove) to the paraphimotic
foreskin and glans.
• You may apply the ice pack for up to 3 minutes at a time, taking
care to monitor for cold or pressure injury.
• There is a significant amount of discomfort associated with ice
packs, so they may not be tolerated in the absence of ...
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