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Paraphimosis Repair: Adult (18 Years and Over)
Paraphimosis Repair: Adult (18 Years and Over)
Paraphimosis Repair: Adult (18 Years and Over)
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E. Risks of not having this procedure
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Record if necessary.)
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General risks:
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• Infection can occur, requiring antibiotics and further
treatment. ...........................................................................................................................................................................
the heart.
• Blood clot in the leg (DVT) causing pain and swelling. In
G. Patient consent
rare cases part of the clot may break off and go to the I acknowledge that the doctor has explained;
lungs. • my medical condition and the proposed procedure,
• Death as a result of this procedure is possible. including additional treatment if the doctor finds
Specific risks: something unexpected. I understand the risks, including
SW9298
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Family name:
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Permission to reproduce should be sought from ip_officer@health.qld.gov.au
Consent Information - Patient Copy
© The State of Queensland (Queensland Health), 2018
Paraphimosis Repair
Adult (18 years and over)
1. What do I need to know about this For the purpose of undertaking professional training in
procedure? this teaching hospital, a student/s may observe the
A paraphimosis repair is the surgical repair of the skin, medical examination/s or procedure/s.
which has tightened at the end of the penis. Subject to your consent, a student/s may perform an
examination/s or assist in performing the procedure/s
while you are under anaesthetic. This is for education
2. My anaesthetic: purposes only. A student/s who undertakes an
This procedure will require an anaesthetic. examination/s or assists in performing the procedure/s
See About Your Anaesthetic information sheet for will be under the supervision of the treating doctor, in
information about the anaesthetic and the risks accordance with relevant professional guidelines.
involved. If you have any concerns, discuss these with If you choose not to consent, it will not adversely affect
your doctor. your access, outcome or rights to medical treatment in
If you have not been given an information sheet, any way. You are under no obligation to consent to an
please ask for one. examination/s or a procedure/s being undertaken by a
student/s for education purposes.
Specific risks:
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• It may be necessary to slit the skin to allow repair.
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• A circumcision may be necessary in the future.
• Swelling in the shaft of the penis and in the ...........................................................................................................................................................................
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