Phimosis and Paraphimosis

Phimosis
Definitions: The preputium of the penis that
cannot be retracted proximal to the
corona glandis.
• occurs in newborns.
• After 3-4 years, 90% of the prepuce can be
retracted, because of the debris produced
by the prepuce epithelium (smegma) in
the prepuce, so that it can separate the
prepuce from the glans penis.
Clinical Features:
• Urine flow disorder: • difficulty urinating,
• reduced urine output
• bulging of the ends
...preputium at miksi
• presence of urinary
retention.
• Postitis (inf. Preputium)
• Lack of local hygiene:
• Balantitis (inf. Glans penis)
• Balanopostitis (both)
• Soft lump on the tip of the penis  corpus smegma bacteria
Diagnosis :
• If the prepusium cannot or in part that could retracted, or be
constriction ring moment pulled back over the glans penis,
must presumed there is a disproportion between widths
prepuce skin and the diameter of the glans penis.
• exist adhesions between surface in the prepusium with
glandular epithelium and / or frenulum breve. Frenulum breve
can causedeviation glans to ventral moment prepuce skin
retracted.
Governance:
• Circumcision u / expands the circle of prepuce skin upon
retraction complete, follow-up 4-6 mg post-op.
• Phimosis + acute local infection and congenital anomalies of
the penis: therapy conservatives can be given corticoid
ointment (0.05-0.1%) twice a day for 20-30 days.
not recommended: u / baby + diaper
Complications:
• recurrent urinary tract infections
• Ca penis
 Paraphimosis

• Definition: Paraphimosis is a skin condition for the prepuce which,

when pulled from the glans penis, cannot be returned to its normal
position to cover the glans penis.
o could interfere with perfusion prepuce surface distal to the
constriction ring and also to the glans penis at risk the occurrence
of necrosis.
Etiology:
• iatrogenic: The health worker accidentally retracts the prepuce while cleaning
the glans penis in sterile urine sampling with catheter placement.
• poor hygiene
• Phimosis
Pathophysiology: chronic inflammation of the prepuce.
The prepusium -> retracted behind the glans -> forms a tight ring ->
around the glans penis -> venous congestion -> swelling of the
glans penis and prepuce. (several hours) -> arterial occlusion ->
infarction or necrosis, gangrene -> autoamputation
Clinical manifestations:
• Penile glans edema + pain
• Too long  swelling  glans penis necrosis.

Diagnosis: careful history and physical examination.

Governance:
• Manual compression 3-5 minutes -> edema- and prepuce
slowly returns
• Dorsum incision in the loop
• Circumcision
Complications:
• tearing of the prepuce ring
• Necrosis
Prevention:
• Maintain hygiene
• circumcision