Phimosis & Paraphimosis Disease

DESCRIPTION

Phimosis: tightness of the penile foreskin which prevents it from being drawn back from over the glans
Paraphimosis: constriction of glans penis by proximally placed phimotic foreskin
System(s) affected: Renal/Urologic, Reproductive, Skin/Exocrine
Genetics: N/A
Incidence/Prevalence in USA: 1% of males over 16 years of age
Predominant age: Infancy and adolescence
Predominant sex: Male only

SIGNS AND SYMPTOMS

Phimosis
- Unretractable foreskin
- Pain on erection
- Superimposed balanitis
Paraphimosis
- Penile pain
- Drainage
- Ulceration
- Swelling

CAUSES

Phimosis
- "Physiologic" - present at birth and resolves spontaneously during the first 2-3 years of life by nocturnal erections which slowly dilate the phimotic ring
- Congenital - unresolved physiologic phimosis
- Acquired - recurrent infection or irritation
Paraphimosis
- Foreskin not pulled back over the glans after cleaning, cystoscopy or catheter insertion

RISK FACTORS

Phimosis
- Poor hygiene
- Diabetes
- Frequent diaper rash in infant
Paraphimosis
- Presence of foreskin
- "Inexperienced" health care provider, i.e., leaving foreskin retracted after catheter placement

LABORATORY

N/A

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

N/A

IMAGING

N/A

DIAGNOSTIC PROCEDURES

N/A

APPROPRIATE HEALTH CARE

Outpatient except for complications

GENERAL MEASURES

Paraphimosis: Reduction if possible (should be done with the patient sedated). Place the middle and index fingers of both hands on the engorged skin proximal to the glans. Place both thumbs on glans and with gentle pressure pushing on the glans and pulling on foreskin, attempt reduction. If unsuccessful, a dorsal slit will be necessary with eventual circumcision after the edema resolves.

SURGICAL MEASURES

Phimosis: Circumcision
Paraphimosis: Dorsal slit with subsequent circumcision

ACTIVITY

No sexual activity following circumcision until healing is complete

DIET

No limitations

PATIENT EDUCATION

If the patient is uncircumcised, appropriate hygiene and care of the foreskin is necessary to prevent phimosis and paraphimosis

PREVENTION/AVOIDANCE

Good patient and parental education

POSSIBLE COMPLICATIONS

Unreduced paraphimosis can lead to gangrene of the glans
Posthitis (inflammation of the prepuce)

EXPECTED COURSE AND PROGNOSIS

Complete resolution if treatment is carried out effectively

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric:

Recurrent balanitis, either chemical or infectious, can lead to an acquired phimosis
Forced reduction of a physiologic foreskin can lead to chronic scarring and acquired phimosis

Geriatric:Recurrent infection and irritations (condom catheters) can lead to phimosis
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.