Paraphimosis is managed initially with which of the following actions?

Paraphimosis is managed initially with which of the following actions?

• A. Observation
• B. Antibiotics
• C. Circumcision
• D. Manual reduction, cool compresses, granulated sugar, hyaluronidase, dorsal slit

Answer: (D)

Paraphimosis is an emergency where the retracted foreskin becomes trapped behind the glans and the tight band can cut off blood flow. The main goal is to relieve the constriction and shrink the swollen tissue so the foreskin can be returned over the glans. Start with manual reduction: gently compress and manipulate the foreskin with plenty of lubrication to slide it forward over the glans. This often works best when the swelling is minimized, so cool compresses around the penile head can help reduce edema. To aid reduction, methods that draw fluid out of swollen tissue or loosen the tissue can be used. A hyperosmolar agent like granulated sugar may reduce edema by pulling fluid away from the tissues, and hyaluronidase can help disperse interstitial fluid to allow easier sliding of the foreskin back into place. If these noninvasive measures fail to achieve reduction, a dorsal slit may be performed to release the constricting band and enable repositioning. Antibiotics aren’t routinely needed unless there’s infection, observation alone risks ongoing ischemia, and circumcision is not the initial management—although it may be considered later in recurrent or unresolvable cases.

Paraphimosis is an emergency where the retracted foreskin becomes trapped behind the glans and the tight band can cut off blood flow. The main goal is to relieve the constriction and shrink the swollen tissue so the foreskin can be returned over the glans.

Start with manual reduction: gently compress and manipulate the foreskin with plenty of lubrication to slide it forward over the glans. This often works best when the swelling is minimized, so cool compresses around the penile head can help reduce edema. To aid reduction, methods that draw fluid out of swollen tissue or loosen the tissue can be used. A hyperosmolar agent like granulated sugar may reduce edema by pulling fluid away from the tissues, and hyaluronidase can help disperse interstitial fluid to allow easier sliding of the foreskin back into place. If these noninvasive measures fail to achieve reduction, a dorsal slit may be performed to release the constricting band and enable repositioning.

Antibiotics aren’t routinely needed unless there’s infection, observation alone risks ongoing ischemia, and circumcision is not the initial management—although it may be considered later in recurrent or unresolvable cases.