OVERVIEW

What is phimosis? What is redundant prepuce?

The glans penis, also known as the head of the penis, is located at the frontmost part of the penis, with the urethral opening passing through it.

The circular groove behind the glans is called the coronal sulcus. The annular, folded skin surrounding the glans is the foreskin. The foreskin consists of an inner layer and an outer layer, and the junction between them is the preputial orifice.

Normally, the preputial orifice is the narrowest part of the foreskin.

If the foreskin covers the glans but can be retracted manually to expose the glans, it is called redundant prepuce; if the foreskin covers the glans and the preputial orifice is too narrow to fully retract and expose the glans, it is called phimosis.

What is paraphimosis?

In cases of phimosis, if the foreskin is forcibly retracted over the widest part of the glans into the coronal sulcus and not promptly or cannot be returned to its original position, it obstructs blood circulation in the distal foreskin and glans, leading to localized swelling and congestion. This condition is called paraphimosis.

Paraphimosis is an emergency requiring immediate medical attention, either through manual reduction or circumcision. Failure to treat it promptly may result in necrosis of the glans.

Is paraphimosis common?

It is uncommon but is an emergency condition that requires early diagnosis and treatment.

SYMPTOMS

What symptoms and manifestations might patients with paraphimosis experience?

The condition primarily presents as penile swelling and pain. In some cases, parents only notice redness and swelling of the foreskin or intermittent dribbling from the urethral opening when the child cries, prompting them to seek medical attention.

• Penile swelling typically appears as a ring-shaped enlargement behind the coronal sulcus (not the entire penis). The degree of swelling often correlates with age, penile erection, nutritional and health status, and the extent of blood flow obstruction after incarceration.

• Penile pain manifests as persistent discomfort, which may gradually worsen.

In advanced stages, patients may experience urinary retention and abdominal distension. In the most severe cases, ischemia symptoms such as blackening of the glans may occur.

What signs might doctors observe during an examination of a patient with paraphimosis?

The glans, located away from the abdominal wall, is referred to as the distal part, while the penile root near the abdominal wall is the proximal part. Typical signs of paraphimosis include:

• Swollen glans: The glans appears significantly enlarged and red (edematous), with noticeable tenderness upon touch. Prolonged incarceration leading to necrosis may result in a blackened appearance without significant tenderness.

• Ring-shaped swelling of the foreskin: This often occurs as an uneven, ring-shaped swelling near the proximal part of the glans, with possible localized severity in one direction.

• Constriction ring: A distinct ring-shaped skin constriction (after excluding foreign objects like rings or rubber bands) may be visible proximal to the swelling. Sometimes, it is obscured by the swelling and requires retraction to observe.

• Loose skin on the penile shaft behind the constriction ring, which remains unaffected and freely movable.

CAUSES

At what age does paraphimosis commonly occur?

This condition can occur in males of all ages with phimosis, though the specific causes leading to paraphimosis may vary slightly.

How does paraphimosis generally occur?

• Infants and young children: Most infants have physiological phimosis. If parents attempt to clean the foreskin or glans improperly during bathing, it may lead to paraphimosis. Alternatively, children may retract the foreskin out of curiosity, which can also cause paraphimosis.

• Young and middle-aged men: Sexual intercourse is the primary cause of paraphimosis. It may also occur if the foreskin fails to retract promptly after nocturnal erections or due to infections (e.g., balanitis) causing thickening and reduced elasticity of the foreskin.

• Elderly men: Reduced skin elasticity increases the risk of paraphimosis. Underlying conditions like diabetes may also predispose them to infections, making paraphimosis more likely.

• Other causes: Medical procedures requiring foreskin retraction (e.g., catheterization, cystoscopy) may lead to paraphimosis if the foreskin is not repositioned afterward.

DIAGNOSIS

How should paraphimosis be diagnosed?

Diagnosis of this condition does not require auxiliary tests such as color Doppler ultrasound or CT. It can generally be confirmed based on clinical manifestations and a penile examination.

What diseases should paraphimosis be differentiated from?

When a patient's physical examination meets the four criteria mentioned earlier, the accuracy of diagnosing this condition is very high. Clinically, it often needs to be differentiated from conditions such as balanitis, insect bites, systemic edema, and penile swelling caused by foreign objects (also known as constriction band syndrome).

Among these, balanitis and insect bites may present with redness, penile swelling, fever, and penile pain or discomfort, but no constricting ring can be found during the physical examination. Systemic edema may be secondary to conditions such as heart or kidney diseases, often initially manifesting as swelling in dependent areas like the scrotum, which may improve when the scrotum is elevated.

TREATMENT

Which department should patients with paraphimosis visit?

This condition is often an emergency and usually requires urgent medical attention. If the condition permits, patients can also visit the urology department.

How should paraphimosis be treated?

The choice of treatment depends on the duration and severity of the condition. The treatment goals are: foreskin reduction, restoration of blood supply and venous return to the penis.

• Foreskin reduction: This involves repositioning the constricting band over the glans to restore the natural state. It should be performed by emergency or urology specialists. During the procedure, care should be taken to avoid skin damage or infection. Pain relief and edema-reducing medications may be used. Successful cases usually require a follow-up in 1–2 weeks to assess for infection. Additionally, doctors may recommend elective circumcision to prevent recurrence.

• Surgery: If reduction fails or the condition has persisted for too long, a dorsal slit (on the back of the frenulum side) is performed to restore blood flow, followed by circumcision at a later stage. If feasible, circumcision may be performed directly.

What happens if paraphimosis is not treated promptly?

The severity of paraphimosis varies, with the worst outcome being glans necrosis.

If blood flow to the glans is not completely blocked, necrosis may not occur, but this should not be relied upon. Anyone experiencing paraphimosis should seek immediate medical attention.

Can paraphimosis be cured?

With early detection, diagnosis, and treatment, it can be cured without leaving any sequelae.

DIET & LIFESTYLE

What should patients with paraphimosis pay attention to in daily life?

• Do not panic excessively, but do not ignore it completely;

• Seek medical attention promptly;

• Avoid attempting self-reduction, especially in severe cases, as it may lead to skin rupture or infection;

• Do not apply ointments, particularly colored ones, as they may interfere with the doctor's diagnosis;

• Try to keep the glans above the penile body in an upright position.

PREVENTION

Can Paraphimosis Be Prevented? How to Prevent It?

• Properly clean the glans and foreskin, and promptly reposition them after cleaning;

• Do not forcibly retract the foreskin, and if retracted, reposition it promptly;

• Reposition promptly after sexual activity;

• If medically necessary or desired by the patient, circumcision should be performed as early as possible.