When initial management of paraphimosis — manual reduction by manipulation using Instillagel as lubricant — has not achieved its intended clinical goals, a structured next-line intervention is indicated. This protocol addresses that specific escalation.
The prior approach, manual reduction using Instillagel, aimed to return the foreskin to its normal position over the glans penis and resolve penile oedema. Failure to meet either of these goals is the indication for this next-line protocol.
The next step incorporates a local anaesthetic nerve block technique at the base of the penis, enabling further reduction attempts under adequate pain control. When the foreskin is significantly oedematous, an additional preparatory step to manage swelling is performed before sustained manual compression is applied. The complete procedural sequence and technique details are in the full protocol.
Successful reduction of paraphimosis with the foreskin returned to its normal position over the glans penis, and resolution of penile oedema.