Etiology
The most common etiology follows retraction of the foreskin of an uncircumcised male penis by a health professional during penile examination, catheterization, or cystoscopy, who then neglects to return the foreskin back over the glans penis.[6][7] Boys, or their parents, may have been advised to retract the prepuce with physiologic phimosis for cleanliness.[6][8] The coexistence of poor hygiene and recurrent bouts of bacterial infection (balanitis) makes this condition more likely. Additional causes of paraphimosis include sexual intercourse in an uncircumcised male with phimosis (narrow opening of the foreskin), varying sexual practices that cause constriction of the foreskin, penile piercings, parasitic infestations, lichen sclerosis, inadequate circumcision, or hemangiomas of the penis.[9][10][11][12] Approximately 29% of patients have evidence of phimosis once the foreskin edema has subsided.[13]
Pathophysiology
Retraction of the foreskin behind the glans penis (in the presence of a phimotic foreskin) leads to the phimotic ring causing constriction of the distal glans. This leads to vascular engorgement as the lymphatic and venous flow from the constricting ring are impaired. This results in secondary edema. The consequences are further vascular compromise as the arterial flow is impaired, and potential ischemia of the penis distal to the phimotic ring. Eventual necrosis of the glans penis may be observed.[14] In other cases, the skin of the glans becomes thickened and dry, which leads to the chronic form of paraphimosis.[Figure caption and citation for the preceding image starts]: Diagram illustrating paraphimosisFrom the collection of Dr Ranjiv Mathews [Citation ends].
Classification
Terminology[1]
Phimosis is a condition where the foreskin is too tight to be pulled back over the head of the penis (glans). Physiologic adherence of the foreskin to the glans is normal, with up to 10% of foreskins remaining nonretractile up to 3 years of age. This reduces to around 1% at the age of 16 years. Pathologic phimosis exists when failure to retract is secondary to distal scarring of the prepuce.
Paraphimosis is a condition in which the foreskin is left retracted for an extended period. Swelling occurs, causing the foreskin to become trapped behind the glans.
Types of paraphimosis
Although most cases are acute, a chronic form may also occur where patients present many days after the initial complaint.
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