Paraphimosis is a condition in which the retracted foreskin cannot be pulled back over the head of the penis. If this persists, swelling can restrict blood flow to the penis, and urgent treatment is needed to prevent gangrene of the penis.
Paraphimosis is most often found in children and in the elderly.
Phimosis refers to a narrowed, non-retractable foreskin, sometimes due to inflammation and infection (often related to poor personal hygiene). Some narrowed foreskins may still be retracted, but if they are left behind the head of the penis for a length of time, swelling sets in, making it even more difficult to return the foreskin to its normal position.
This state of paraphimosis can obstruct urine flow, and compromise the blood supply to the tip of the penis, which may become gangrenous and require amputation.
The diagnosis is obvious: the patient has pain, with a swollen penis tip, and a retracted foreskin forming a tight band just behind the glans (head of the penis).
In some cases, the foreskin can be manually replaced by compressing the glans and encouraging the lubricated foreskin to return to its normal position.
If this does not succeed, surgery is required. A slit may be cut in the foreskin to release it, but this is usually just a temporary measure. Definitive treatment is circumcision.
If circumcision is not possible, the patient (or his caregivers) must be educated to ensure that the retracted foreskin is always replaced, for instance after cleaning or catheter insertion.
Provided the paraphimosis is dealt with rapidly, there is no permanent damage.
(Dr A G Hall)