Reduction of Paraphimosis with Hyaluronidase

Litzky, Gerald M.

doi:10.1016/s0090-4295(97)80012-x

Cited by 6 publications

(6 citation statements)

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“…Other options for managing this entity include the hyaluronidase method which includes the injection of 1-ml aliquots of hyaluronidase (using a tuberculin syringe) into one or more sites of the oedematous prepuce, as reported by Litzky [3] and DeVries et al [4]. Hyaluronidase disperses extracellular oedema by modifying the permeability of intercellular substance in connective tissue.…”

Section: Discussionmentioning

confidence: 99%

Mannitol for Paraphimosis Reduction

Alladi¹,

Kapoor

2012

Urol Int

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Introduction: Paraphimosis is a urologic emergency. Many treatment options have been devised for managing this entity. The osmotic method is one of them. We used an osmotic diuretic, mannitol, for reducing paraphimosis. Mannitol is commonly used for conditions like head injury to decrease cerebral oedema, partial nephrectomy and hepatorenal syndrome; we attempted using this diuretic for reducing paraphimosis. This is a novel technique and an application of mannitol which has never been reported before. Methods: Starting in February 2011, we used mannitol 20% in patients presenting to urologic emergency with uncomplicated paraphimosis. Mannitol-soaked gauzes were wrapped around the oedematous prepuce, followed by minimal intermittent hand compression and frequent resoaking of the gauze with 20% mannitol. No needle punctures were made. The soaked gauze was removed and the paraphimosis was reduced easily. Results: A complete reduction of paraphimosis occurred after mannitol-soaked gauze had been placed over the oedematous prepuce for about 30–45 min in 6 of our patients. This is a novel agent used for this entity; it reduces paraphimosis in a minimal time with no pain, with the added advantage of the least risk of infection after the procedure as opposed to granulated sugar or 50% dextrose previously used as osmotic agents. Conclusions: Mannitol can be applied in clinical practice for reducing paraphimosis. It requires no anaesthesia and is associated with minimal/no patient discomfort unlike that seen with multiple needle punctures and the various other non-osmotic methods of reducing paraphimosis.

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Section: Discussionmentioning

confidence: 99%

Mannitol for Paraphimosis Reduction

Alladi¹,

Kapoor

2012

Urol Int

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“…These agents reduce swelling by creating a high solute concentration gradient that draws fluid from the edematous foreskin tissue; it can take 1e2 h to see a noticeable effect [5,6]. Another reported technique to reduce foreskin edema is the use of hyaluronidase, but this may be considered more invasive given the need for injection of this substance into the edematous paraphimotic foreskin [14].…”

Section: Ice and Pharmacologic Agentsmentioning

confidence: 99%

Simple method of paraphimosis reduction revisited: Point of technique and review of the literature

Pohlman

Phillips

Wilcox

2013

Journal of Pediatric Urology

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Paraphimosis is a urologic emergency that has the potential for serious penile injury, including gangrene and tissue necrosis, if left unattended for a period of time. Multiple different techniques for reduction of paraphimosis have been proposed. We present a novel approach to paraphimosis reduction that utilizes CoFlex(®), a flexible self-adhering bandage. We also present a detailed review of the literature of conservative management options for paraphimosis.

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“…The injection of hyaluronidase into one or more sites of the oedematous prepuce has been claimed to facilitate reduction of paraphimosis. 2,22,27,28 It is thought that hyaluronidase disperses extracellular oedema by modifying the permeability of intercellular ground substance in connective tissue, enhancing diffusion of trapped fluid between the tissue planes to decrease the preputial swelling. 2,3,29 Some consider the key to this method of reduction is not the effects of the hyaluronidase, but rather, the punctures made by the syringe needle.…”

Section: Hyaluronidasementioning

confidence: 99%

“…An 18-25G needle is used to puncture one or several openings into the oedematous prepuce distal to the constricting ring to allow oedematous fluid to escape from the puncture sites with manual compression of the glans and prepuce. 2,[22][23][24][25][26] (Figure 4) External drainage of the trapped fluid results in effective diminution of the swelling, facilitating subsequent manual reduction. 3,6,13,25 After reduction, topical and oral antibiotics have been suggested.…”

Section: Puncture Techniquementioning

confidence: 99%

Emergency Management of Paraphimosis

Chung¹

2003

Hong Kong Journal of Emergency Medicine

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Objective To review the treatment modalities available for paraphimosis, with special emphasis on those applicable to the emergency department. Data source Relevant medical literature was searched through MEDLINE, EMBASE, CINAHL, and Cochrane Database. Manual search was performed in books on Urology, General Surgery and Emergency Medicine available in the Hospital Library. Further information was obtained through the Internet at < www.infoseek.com >. References cited in articles were also retrieved. Study selection Key words for the literature, Internet and textbook search were ‘paraphimosis’ and ‘treatment’. All available years of study were reviewed. Data extraction Relevant full text articles were obtained through the hospital library network. Original articles, review papers, medical practice, case reports, and relevant book chapters were reviewed. Data synthesis There were no prospective, randomised, controlled studies available. The majority were case series and expert experience or opinions only. Currently, a multitude of non-invasive and invasive treatment options are available, including manual reduction, help of non-crushing tissue forceps, puncture technique and dorsal slit. Conclusion All treatment methods are within the capability of the emergency physician. Hospitalization should rarely be required, unless there are serious complications.

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Reduction of Paraphimosis with Hyaluronidase

Cited by 6 publications

References 1 publication

Mannitol for Paraphimosis Reduction

Mannitol for Paraphimosis Reduction

Simple method of paraphimosis reduction revisited: Point of technique and review of the literature

Emergency Management of Paraphimosis

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