Paraphimosis

Disclaimer

These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Paraphimosis requires immediate referral to the nearest Emergency Department.

Keep nil by mouth until the child is reviewed by medical staff.

Introduction

Paraphimosis occurs when the foreskin is retracted and unable to be returned to the natural position over the glans. The retracted foreskin constricts venous flow leading to pain and oedema. If not reduced, significant tissue damage may occur.

Most children will present directly to the Emergency Department. If a child presents to the primary practice setting a clinician confident in the technique of reducing a paraphimosis may attempt a reduction with adequate analgesia.

The child should be referred immediately to the Emergency Department in the following cases:

The paraphimosis is not resolved in a single attempt
The clinician is not confident performing the procedure
The clinician is unable to provide adequate analgesia to attempt the reduction.

Older children and adolescents may present late due to embarrassment and fear

Pre-referral investigations

No pre-referral investigations are required.

Pre-referral management

Attempt to reduce only if confident in procedure and able to give adequate analgesia.
If unsuccessful after one attempt, refer to the Emergency Department immediately. Keep fasted until review.

Useful resources

Paraphimosis - ED guideline

References

Clifford ID, Craig SS, Nataraja RM, Panabokke G. Paediatric paraphimosis. Emergency Medicine Australasia. 2016;28(1):96-9.
Perth Children's Hospital. Paraphimosis [Webpage]. Perth: Child and Adolescent Health Service 2018 [cited 2021 March]. Available from: https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Paraphimosis.

Reviewer/Team:	Mr Gera, HoD General Surgery, PCH	Last reviewed:	Sep 2021
		Next review date:	Sep 2024
Endorsed by:	Fast track approval	Date:	Sep 2021

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