What is paraphimosis. Paraphimosis in children and men: treatment of infringement of the head with the foreskin

Paraphimosis in urological practice is considered as an emergency condition requiring qualified intervention. Against the background of such a pathology, the glans penis is infringed by the inner leaf of the foreskin. Puffiness is manifested due to the fact that the head is in close contact with the surrounding tissues.

Such a process is closed, because the swelling of the head is constantly increasing due to active compression. With untimely intervention, there is a risk of necrosis of the head tissues.

There is a possibility of developing sepsis. In complicated cases, amputation of the head of the penis is performed.

Causes of paraphimosis

The main cause of paraphimosis in men is phimosis. Pathology manifests itself if the prepuce ring quite strongly squeezes the male genital organ.

When the process of blood supply is disturbed and the blood stops flowing to the tissues, then the narrowing of the urethra appears, and acute pain occurs.

The causes of pathology in men can be represented as:

• diabetes;
• violation of the elasticity of skin folds;
• cicatricial changes on the frenulum of the penis;
• intensive;
• uncomfortable posture during intercourse or active sex;
• dermatological pathologies of the penis;
• allergic reactions that occur in the perineum;
• syphilis;
• pathologies of the cardiovascular system;
• performing cystoscopy.

This pathology manifests itself in children and adolescents, despite the fact that the risk of its occurrence is also present in men of different ages.

Children with a predisposition to pathology, the diagnosis of phimosis. The main reason for the development of the disease is the forced opening of the glans penis. Parents should pay attention to the fact that in boys with congenital phimosis, the head is exposed only by the beginning of puberty, and any attempts to force its opening can become a factor in the development of a serious pathology.

If any disturbing changes appear, you should consult a doctor - such a lesion is dangerous for men of different ages.

Symptoms of paraphimosis

It is rather difficult to miss the moment of the onset of the development of the pathology, since the disease has quite pronounced symptoms. The list of characteristic manifestations includes the following signs:

• acute pain, which can intensify at the moment of touching the organ;
• swelling of the head of the penis;
• redness ;
• delay and painful urination.

These symptoms are the first manifestations of paraphimosis. If the patient ignores their education, his condition will be aggravated:

• spots appear on the penis, indicating the start of the process of tissue necrosis;
• the affected areas lose their own sensitivity;
• despite the change in the appearance of the penis, the pain disappears - this indicates the death of the nerve endings;
• the penis becomes covered with a crust, the head acquires a dark color;
• an unpleasant odor emanates from the penis.

The most dangerous complication of this condition is gangrene, which often ends in amputation. There is a risk of blood poisoning.

Timely detection of signs of phimosis in a child is the task of attentive parents, which ensures the successful treatment of such a pathology.

Symptoms characteristic of such a disease are manifested as follows:

• the inflammatory process at an early stage of development does not provoke manifestations of organ modifications;
• an acute attack of pain occurs somewhat later;
• on external examination, it is noticeable that the foreskin takes the form of a pressing ring;
• swelling usually increases, against this background, the head of the penis increases in size;
• head changes color to darker.

Children under the age of 4 can rarely describe how they feel. In this case, the child tries to inform his parents about his condition by the following actions:

• tearfulness;
• increased irritability;
• touching the penis;
• sleep disorders.

A caring mother should constantly monitor the condition of the child's genitals.

Complications

Paraphimosis is the cause of the manifestation of the following pathological changes:

• the process of blood supply and lymph flow is disturbed;
• there is a pronounced edema, which complicates the process of urination;
• seals appear in the penis, which are easily palpable.

The attention of men should be stopped on the fact that there are no methods at home. Such a disease should be eliminated under the supervision of a specialist.

The outcome of self-treatment using improvised means and methods traditional medicine may be unfavorable. The list of complications dangerous for a man can be presented as follows:

It is necessary to carefully observe the hygiene rules for caring for the baby

1. infection;
2. gangrenous lesion;
3. the formation of ulcers and fistulas on the surface of the cover.

These complications have an unfavorable prognosis; in some cases, amputation of the penis is required to eliminate the consequences.

Diagnostics

Diagnosis of the pathological process does not cause difficulties for an experienced surgeon. To determine the diagnosis, an examination of the patient is carried out. The urologist collects an anamnesis:

• clarifies information about the process of exposing the glans penis to pathological changes;
• establishes the moment of manifestation of puffiness;
• clarifies the presence of concomitant symptoms.

During the initial examination, the doctor assesses the condition of the glans penis and compares its color with the normal one. After receiving an informative clinical picture, the optimal method of treatment is determined. If the urologist is inclined to perform the operation, then a consultation with the surgeon is indicated.

Treatment of paraphimosis

Treatment will be started without delay, after identifying signs of paraphimosis. Therapy of the disease is carried out by specialists:

• urologist;
• andrologist;
• surgeon.

Paraphimosis is considered as an emergency condition. You need to seek medical help as early as possible, sometimes there is a risk of developing irreversible changes that appear after 20-30 minutes. If this condition is detected in a child, it is worth calling emergency care or contacting a pediatric urologist, surgeon.

With timely access to qualified help, it is possible to avoid dangerous complications that require surgical treatment.

First aid measures

It is forbidden to treat paraphimosis on your own. It is possible to alleviate the patient's condition before the arrival of the ambulance team by applying the following methods:

• The impact of cold. Cold contents, such as ice, are wrapped in a towel and applied to for several minutes. The patient's attention should be stopped on the fact that it is impossible to hold the compress for a long time - the development of irreversible complications is likely.
• Salt application. Enough effective method allowing to stop pain and puffiness. Dissolve 3-5 tablespoons of edible salt in a liter of water. A piece of gauze is moistened in the solution and applied to the site of inflammation. It is unacceptable to use such a tool if there are cracks on the organ.
• Corticosteroid ointment will help relieve pain.

The urologist can diagnose the disease after examination

If such a complication manifests itself in a child, the use of a cold compress is acceptable. Ice should be applied for no more than 5 minutes. You can repeat the procedure after 10 minutes. If the baby complains of acute pain, let's take painkillers.

Treatment Methods

Two methods can be used to treat pathology:

1. surgical intervention;
2. medical treatment.

The use of a conservative method of therapy is permissible only if the patient consulted a doctor in a timely manner. In this case, the glans penis is repositioned into the pinching ring. The procedure is painful, therefore it is carried out with the use of special lubricants.

Before the intervention, a puncture is performed to ensure the removal of accumulated fluid. Manipulation is carried out after anesthesia. Children are advised to enter general anesthesia, if there are no contraindications. After the operation, the penis is treated with a sanitizing solution, emollients and anti-inflammatory drugs are used.

Treatment can be either conservative or surgical.

Sometimes the use of a conservative method of therapy does not lead to results. In this case, the problem is solved in a radical way. There is a longitudinal excision of the foreskin. In order to prevent the recurrence of pathology, it is recommended to carry out circumcision after 2-3 months.

Prevention of paraphimosis

It is possible to prevent the development of the disease in a child, subject to the basic methods of prevention. If a child develops phimosis, experts recommend that the procedure be carried out in a timely manner. Timely excision of the flesh reduces the likelihood of narrowing and allows you to increase the susceptibility of the foreskin.

Parents should stop their attention on the need for regular hygiene procedures. Parents should go for regular checkups with their child to a pediatric surgeon and follow all his recommendations.

It is forbidden to move the foreskin to ensure the process of urination and ensure hygiene procedures. The question of opening the head and the need to respond to such a violation should be asked to the surgeon.

Parents should remember that it is worth instilling the basics of hygiene in a child at the age of three.

• For regular hygiene procedures, it is worth using soap with an antibacterial component. A man should remember that sometimes such compounds dry out the skin, which can cause injury.
• For the prevention of various infectious diseases, it is worth using barrier contraceptives.
• Mobile lifestyle.
• Quitting smoking and drinking alcohol.
• Compliance with the basics of proper nutrition.

A man should regularly conduct an examination of the penis. If you notice any symptoms, you should consult a doctor. Paraphimosis is a dangerous pathology that manifests itself in men of different ages.

Children also face it. Cases of complications are not uncommon, unfortunately, the main reason for such consequences is a man’s neglect of his own health.

Timely medical assistance is the key to a full recovery without consequences for men's health.

- an acutely developed condition in which the narrowed foreskin infringes on the head of the penis and cannot spontaneously return to its normal position. Paraphimosis is characterized by severe pain in the area of ​​infringement, an increase in volume and cyanosis of the glans penis, swelling of the foreskin, which looks like a dense swollen roller, difficulty urinating. The diagnosis of paraphimosis is based on the results of an external examination of the penis and anamnestic data. Treatment of paraphimosis may include conservative bimanual reduction of the strangulated glans penis and surgical methods - puncture of edematous tissues, longitudinal dissection of the foreskin (incision), circular excision of the foreskin (circumcisio).

ICD-10

N47 Excessive foreskin, phimosis and paraphimosis

General information

If long time it is not possible to return the foreskin to its original position, paraphimosis can be complicated by ischemia and partial necrosis of the glans penis, the development of ischemic gangrene of the foreskin ring. Partial autoamputation of the distal part of the penis is possible.

Treatment of paraphimosis

If paraphimosis occurs, an immediate appeal to a doctor is necessary: ​​a pediatric surgeon, urologist or andrologist. The diagnosis of paraphimosis is established on the basis of anamnestic data and visual examination of the penis.

First aid

Paraphimosis is an emergency that requires urgent medical attention. First aid for paraphimosis consists in applying cold to the site of infringement (ice pack, cold compress); applying a bandage with a hypertonic solution, an elastic compressive bandage; carrying out applications of local anesthetics, injections of hyaluronidase into the edema area. These activities not only reduce pain, but also reduce swelling of the glans penis.

Conservative therapy

Treatment of paraphimosis can be conservative and operative. With the timely detection of paraphimosis, a conservative bimanual reduction of the glans penis into the infringing ring of the foreskin is performed under local (in children - general) anesthesia after lubricating the surface of the penis with vaseline oil or glycerin. Sometimes a puncture of edematous tissues of the foreskin is preliminarily performed to create an outflow of fluid. After the successful reduction of paraphimosis, local baths with a solution of potassium permanganate, applications of camphor oil, prednisolone ointment are prescribed.

Surgery

If 2-3 attempts to reposition the glans penis are unsuccessful, a preliminary longitudinal (dorsal) dissection of the infringing ring is performed. Since paraphimosis is accompanied by deformation of the foreskin, in order to avoid repeated cases of infringement, 1-1.5 months after the acute process subsides, a circular excision of the foreskin (circumcisio) is performed. Currently, circumcision is often performed using a laser or a radiosurgical scalpel. For the prevention of postoperative infectious complications, antibiotics and restorative therapy are prescribed.

Forecast and prevention

With timely access to a doctor and carrying out surgical treatment paraphimosis, the prognosis of the disease is favorable. Advanced cases of paraphimosis threaten with necrosis and ischemic gangrene of the glans penis, the need for its amputation. Prevention of paraphimosis consists in early diagnosis and treatment of phimosis, prohibition of premature forced retraction of the foreskin, and careful urological manipulations. To detect phimosis, adolescent boys must be examined

Paraphimosis - infringement of the base of the glans penis by the inner surface of the foreskin when trying to retract it beyond the expanded part of the head (crown) into its narrowed part (neck).

Paraphimosis in boys is most common, but can also be observed in adulthood. The main condition for the development of paraphimosis is a decrease in the elasticity of the foreskin or its deficiency (phimosis). Naturally, men who have been circumcised are not threatened with this disease. Insufficient elasticity of the foreskin covering the head can be congenital and acquired.

Congenital, physiological, observed in boys before the onset of secretion into the preputial sac of glands located in the walls of its generatrix (the surface of the glans penis and the inner layer of the foreskin). Prior to this, they are in a state of "epithelial bonding" without any sensation of discomfort in the child. Spontaneous physiological opening of the glans penis in children can occur in the period from 3-7 to 10-11 years.

Independently, in the absence of any signs of pain in the head area, this event should not be forced. Any attempt to forcibly expose the head is sharply painful and leads to subsequent guaranteed inflammation of the walls of the preputial sac that were previously in a sterile state, which are not yet ready to independently respond to various external stimuli. The result of such violent actions can be a true, acquired phimosis that has developed in a boy. Reaching a certain degree of narrowing, with a subsequent attempt to expose the glans penis, its infringement occurs - paraphimosis.

In adult men, paraphimosis occurs more often during sexual intercourse or masturbation.

Iatrogenic paraphimosis is also distinguished, which occurs when a doctor performs bladder catheterization, cystoscopy.

There are the following reasons suggesting the risk of infringement of the glans penis with existing phimosis:

• Short frenulum of the foreskin;
• Chronic inflammation of the mucosa of the foreskin and glans penis () in case of non-compliance with the rules of personal hygiene;
• Allergy to detergents or irritation of the mucosa with their components;
• Sexually transmitted diseases (primary);
• Systemic (fungal diseases);
• Delayed excretion of fluid from the body in chronic diseases of the cardiovascular system, chronic renal failure and liver disease;
• Penis piercing.

Symptoms of paraphimosis

Acute symptoms of paraphimosis are characteristic for the forced exposure of the head of the already narrowed foreskin and the impossibility of its return to its original state. This is accompanied by severe pain. It is followed by a gradual increase in edema of the skin of the foreskin, which takes the form of a swollen shaft at the crown of the head.

The leathery roller initially having a "watery" appearance, with a shiny pale gray surface, takes on a red-blue color. The head of the penis begins to increase in size, becomes sharply painful and changes its color to dark shades of blue.

Urination occurs with significant difficulty, acute urinary retention develops with the simultaneous appearance of pain in the suprapubic region. Painful sensations become so intense that the man takes a sparing pose: a torso tilted forward with legs wide apart.

Paraphimosis in boys to the already given symptoms may be accompanied by an increase in overall body temperature.

If self-reduction on initial stages the development of the disease was not carried out, medical care was not provided, soft tissue edema continues to grow. This leads to hypoxia of the soft tissues of the glans penis, followed by the development of gangrene of the foreskin and necrosis of the glans itself. In advanced cases, self-amputation of dead tissues of the penis is possible.

Under these conditions, the sudden cessation of pain with treatment that has not yet begun can serve as an unfavorable prognostic sign.

The described symptoms of paraphimosis may be less acute at the very beginning of paraphimosis with the gradual development of swelling of the skin of the penis in patients with severe chronic diseases of the internal organs.

For the diagnosis of paraphimosis, local examination in combination with characteristic complaints is quite enough.

Treatment of paraphimosis

The tactics of treating paraphimosis is determined by a specialist doctor (surgeon, urologist) to whom the patient should be immediately delivered.

At home, a single self-sparing reduction of the head is permissible in cases of non-critical phimosis of the foreskin.

A positive result can be facilitated by preliminary local exposure to a member of a cold compress (towels moistened with cold water) or an ice pack. The removal of soft tissue edema before reduction can also be facilitated by the application of a bandage with a hypertonic saline solution (3 tablespoons per 1 liter of cooled boiled water).

Exposure to cold and table salt should not be prolonged and cause more intense pain than already felt by the patient. Treatment of paraphimosis with salt in the presence of eroded surfaces on the foreskin and the surface of the head of the penis is unacceptable. The application of a cold compress for the purpose of pain relief and relief of local swelling can be continued during the transport of the patient to the hospital.

The doctor in the hospital performs a bimanual reduction of the head. In men, this procedure is performed using local anesthesia, while children require general anesthesia during reduction. The essence of the procedure is to press with two thumbs on the head while fixing the other fingers of the infringing ring of the foreskin. Previously, the skin of the penis and the head are lubricated with vaseline oil. Sometimes the doctor can precede reduction with multiple superficial punctures of edematous tissues to free them from excess fluid, which he applies with a sterile needle from a syringe.

repositioning of the head in paraphimosis

After bimanual reduction, local anti-inflammatory procedures are prescribed in the form of baths with potassium permanganate, the use of anti-inflammatory ointments.

If attempts at reduction (no more than three) do not end with a positive result, the doctor performs a longitudinal dissection of the skin of the foreskin, followed by the release of the head from compression.

For the prevention of repeated infringements, such patients are subsequently recommended a planned operation - circular excision of the foreskin (circumcision). It is produced after the subsidence of local inflammatory manifestations, as a rule, one and a half months after the occurrence of paraphimosis.

Video: paraphimosis - signs and emergency treatment, Dr. Komarovsky

Paraphimosis sometimes occurs in older men during bladder catheterization. Also, paraphimosis can develop with swelling of the displaced foreskin.

Diagnosis of paraphimosis in men

Anamnesis

The patient should be asked if abduction of the foreskin is possible under normal conditions (assuming a normal foreskin if positive and phimosis if negative).

Inspection

In most cases, palpation with paraphimosis causes pain. The foreskin is swollen. The swelling can be so pronounced that it can be confusing for those who first experience this condition. Sometimes with paraphimosis lasting several days, small ulcers may appear on the foreskin, which can also be confusing and make you think of an infectious or malignant disease.

Treatment of paraphimosis in men

There are several treatment options. Quite often, before contacting a doctor, patients independently squeeze the foreskin in order to reduce swelling. On examination, doctors try to do the same, but quite often these attempts are unsuccessful.

Ice Glove Method: Apply lidocaine gel to the glans penis and foreskin. Wait 5 minutes (time of onset of anesthesia). Take a glove and pour ice water into it, then tie off the sleeve of the glove so that the contents do not leak out of it. Also tie four fingers of the glove. Place thumb gloves on the penis so that the latter lies on it, in contact with ice and water. This may reduce swelling of the foreskin.

Granulated sugar can also be used to reduce swelling (due to the osmotic effect). Sugar can be placed in either a condom or a glove that is worn over the glans penis and foreskin.

Perhaps the introduction of hyaluronidase (1 ml; 150 IU) into the foreskin (needle number 25). Destruction hyaluronic acid reduce swelling of the foreskin.

Dundee technique: after the patient has taken a broad-spectrum antibiotic, such as ciprofloxacin, a circular blockade is performed at the base of the penis (needle No. 26), 10 ml of a 1% lidocaine solution or 10-20 ml of a 0.5% solution of bupivacaine (marcaine). After 5 minutes, press the foreskin to make sure that there is no pain sensitivity. Prick the skin of the penis with a sterile needle and ask the patient if he felt this prick, which can also indicate sufficient or insufficient anesthesia. Sometimes local anesthesia is not enough, and general anesthesia is required. In children, as a rule, they resort to general anesthesia. Cleanse the skin of the foreskin and glans penis with a cleansing solution. Using a size 25 needle, make about 20 punctures in the swollen foreskin. Squeeze the foreskin tightly to help drain fluid from the foreskin. In this case, small streams of liquid will be visible. When the patient is discharged for prevention purposes, a 7-day intake of ciprofloxacin is prescribed and daily baths are recommended. The patient should know that the extreme should be wiped gently, after which it should be returned to its original position.

Since the introduction of the Dundee technique in paraphimosis in 1996, there has never been a need to incise the foreskin. This method was used if the duration of paraphimosis was a week. Approximately one third of patients underwent circumcision due to the presence of phimosis.

If this method does not eliminate paraphimosis, resort to traditional surgical treatment - dissection of the foreskin, performed under general anesthesia or after a circular blockade of the penis.

An incision is made at the site of compression. The foreskin should be pulled back towards the head of the penis, making sure that it can move easily. When applying a longitudinal incision, the sutures are applied in the transverse direction, which increases the circumference of the foreskin, preventing the re-development of paraphimosis.

In such cases, circumcision is not attempted immediately, as a gross change in the normal anatomy of the foreskin may complicate the circumcision and lead to a lower cosmetic result.

Paraphimosis in men is a rare but harmful disease. Representatives of a strong part of humanity quite acutely and painfully endure deviations and problems in the sexual sphere, however, with all this, they often drag it to the last, and wait for the problem to recede on its own. Difficulties in this area often affect the testicles and penis, making morphological changes and significant adjustments to sexual life, making sexual intercourse painful or impossible. Many have probably heard about such a problem as phimosis, and in this article we will consider one of its complications - paraphimosis, look at the symptoms and causes, and see how to treat paraphimosis in men.
As you know, phimosis is closely related to the foreskin and implies the impossibility of exposing the head of the penis, which can affect the receipt of a secondary infection, urination, pain. Often the trouble is laid in childhood, and it is necessary to deal with it there. Paraphimosis in men- nothing more than a complication that occurs against the background of undertreatment of phimosis, during which the head of the penis is exposed during erection, but a situation arises that after that it cannot be returned to its place, and often a skin ring is formed that pinches it and prevents it from returning to its original position. In many ways, this situation occurs when exposed to the penis (erection, masturbation) and can be caused artificially, but there are also clear predispositions to the manifestation of this disease. Often this situation occurs at a young age, and then they talk about. A short frenulum of the foreskin, excess foreskin, sexually transmitted diseases, balanoposthitis are capable of contributing to the manifestation of the disease. Almost always there is phimosis or its uncured form.
Paraphimosis symptoms very similar to phimosis and make themselves felt very soon:

• severe pain when urinating
• the head of the penis is pinched by the foreskin,
• swollen, reddens or turns blue, an uneven and dense ring of skin is clearly visible around it
• when touching the penis, a sharp piercing pain appears.

These signs are so obvious and painful that it is simply impossible not to notice them. In such a situation, you need to take action and treatment paraphimosis in men.

You should immediately consult a doctor and get qualified help. It is allowed to apply ice in a bag to the head to remove the tumor, and also to squeeze it with two fingers to prevent the tumor from growing. However, it should be understood that all these are temporary measures that are not able to correct the situation completely and save you the existing problem.

Treatment of paraphimosis in men can go in two ways:

• conservative. Initially, the doctor tries to solve the problem without resorting to drastic measures. There is local anesthesia of the head of the penis, its significant treatment with petroleum jelly, squeezing in order to reduce swelling and subsequent swelling, mechanical return of the head into place by pushing through the ring. After these manipulations, if everything went well, the penis is fixed to the stomach perpendicular to the ground in order for the fluid to drain and the inflammation to subside.
• operating room. If the measures described above are not possible due to a too dense ring around the head, then the doctor uses a surgical method - dissection of the foreskin. After the blood circulation is normalized and the head returns to its original place, the foreskin is circumcised so that a relapse does not occur, as a result, the head receives complete release from the flesh and always remains open.