II. Indications
-
Phimosis
- Urinary Obstruction
- Urinary Catheter placement
III. Complications
- Injury to glans penis or Urethral meatus
- Foreskin adhesion
- Failed Procedure
IV. Precautions
- Exercise caution and procede gently with manual attempts
- Aggressive Foreskin Stretching and retraction increases pain and may increase adhesion risk
V. Technique
- Clean area and apply antiseptic (e.g. Hibiclens)
- Drape region
-
Anesthetic
- Consider Dorsal Penile Nerve Block
- Locate the opening of the foreskin Phimosis
- Insert a hemostat into the Phimosis between the glans and the foreskin
- May initially insert a smaller metal probe to characterize the opening and the space
- Gently spread open the hemostat to break adhesions and separate the glans from the foreskin
- Consider a dorsal slit
- May be indicated if the Foreskin Dilation with hemostat alone is insufficient
- Procedure is identical to the dorsal slit performed during the Gomco Clamp Circumcision
- Perform Dorsal Penile Nerve Block first
- Insert single side of hemostat into the Phimosis
- Confirm the clamp is along the inner foreskin and that glans penis is not interposed
- Close the hemostat around the foreskin, creating a clamped, crushed region of foreskin
- Remove the hemostat and cut a single pass through the clamped skin with a straight scissors
VI. References
- Warrington (2023) Crit Dec Emerg Med 37(9): 18