II. Indications

  1. Phimosis
    1. Urinary Obstruction
    2. Urinary Catheter placement

III. Complications

  1. Injury to glans penis or Urethral meatus
  2. Foreskin adhesion
  3. Failed Procedure

IV. Precautions

  1. Exercise caution and procede gently with manual attempts
  2. Aggressive Foreskin Stretching and retraction increases pain and may increase adhesion risk

V. Technique

  1. Clean area and apply antiseptic (e.g. Hibiclens)
  2. Drape region
  3. Anesthetic
    1. Consider Dorsal Penile Nerve Block
  4. Locate the opening of the foreskin Phimosis
  5. Insert a hemostat into the Phimosis between the glans and the foreskin
    1. May initially insert a smaller metal probe to characterize the opening and the space
    2. Gently spread open the hemostat to break adhesions and separate the glans from the foreskin
  6. Consider a dorsal slit
    1. May be indicated if the Foreskin Dilation with hemostat alone is insufficient
    2. Procedure is identical to the dorsal slit performed during the Gomco Clamp Circumcision
    3. Perform Dorsal Penile Nerve Block first
    4. Insert single side of hemostat into the Phimosis
      1. Confirm the clamp is along the inner foreskin and that glans penis is not interposed
      2. Close the hemostat around the foreskin, creating a clamped, crushed region of foreskin
      3. Remove the hemostat and cut a single pass through the clamped skin with a straight scissors

VI. References

  1. Warrington (2023) Crit Dec Emerg Med 37(9): 18

Images: Related links to external sites (from Bing)

Related Studies