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
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Therapeutic or Preventive Procedure (T061) |
| SnomedCT | 33247004 |
| English | Dilation of foreskin, except newborn, Stretching of foreskin, except newborn, Dilation of foreskin, except newborn (procedure) |
| Spanish | dilatación del prepucio, excepto en el recién nacido (procedimiento), dilatación del prepucio, excepto en el recién nacido, estiramiento del prepucio, excepto en el neonato |
Ontology: Stretching of prepuce (C0403334)
| Concepts | Therapeutic or Preventive Procedure (T061) |
| ICD9 | 99.95 |
| ICD10 | 92132-00 |
| SnomedCT | 150677007, 176549001 |
| English | Stretching of foreskin, Stretching of prepuce, Foreskin stretch, Stretching of prepuce (procedure) |
| Spanish | alargamiento del prepucio (procedimiento), alargamiento del prepucio |
