This protocol addresses paraphimosis that has not resolved after a first-line attempt using ring block anaesthesia and sustained manual compression. The clinical goals remain the same — successful resolution of paraphimosis and full resolution of penile oedema — but the approach at this stage is different.
Penile ring block (Lidocaine without adrenaline) with sustained digital compression — and where indicated, needle decompression of oedematous foreskin followed by sustained compression — has been attempted without achieving the required outcome.
When ring block and compression have failed, management moves to a procedural intervention under anaesthesia. The setting and specific procedure depend on clinical assessment. The full protocol specifies which options are available and when each applies.
Successful resolution of paraphimosis · resolution of penile oedema. Timely intervention is essential to prevent complications and restore normal anatomy.
If the above measures fail then consider a dorsal slit under LA or reduction, dorsal slit or circumcision under GA.
Timely and appropriate management of paraphimosis is essential and involves urgent intervention to reduce swelling and restore normal blood flow to alleviate patient discomfort as well as to prevent complications that can lead to increased morbidity and healthcare utilisation.
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