Paraphimosis

Diagnosis is based on history and physical examination.

History

Adult patients will most often report penile pain. Pediatric patients may present with symptoms of obstructive voiding (i.e., a sensation of incomplete emptying, straining to void, and slow urine stream). It is important to determine the duration of the episode of paraphimosis, as manual reducibility may be compromised in those who have had a prolonged course. Additionally, this information will be useful in counseling patients and families about the potential for tissue loss (e.g., glans or foreskin).

Physical exam

On examination, the glans penis is enlarged and congested with a collar of edematous foreskin. A constricting band of tissue will be observed directly behind the head of the penis. The remainder of the penile shaft will be unremarkable.

The glans and foreskin should be evaluated for early signs of necrosis. A soft, pink, pliable glans is reassuring for the presence of a blood flow. Areas that appear black, or the presence of a non-pliable glans, are concerns for the presence of early necrosis.

Many patients will have an indwelling catheter. An indwelling catheter is used if the patient cannot urinate normally. This may happen with some medical conditions such as prostate enlargement or after surgery on the pelvis or urinary tract. Another reason for a catheter is urinary incontinence. After the reason for the placement of the catheter has been determined, the catheter should be removed before attempting reduction of the paraphimosis.

In children, paraphimosis may present as acute urinary obstruction.[Figure caption and citation for the preceding image starts]: Diagram illustrating paraphimosisFrom the collection of Dr Ranjiv Mathews [Citation ends].[Figure caption and citation for the preceding image starts]: ParaphimosisFrom the collection of Dr Ranjiv Mathews [Citation ends].[Figure caption and citation for the preceding image starts]: Paraphimotic ringFrom the collection of Dr Ranjiv Mathews [Citation ends].