SAQ 70 – Urology – paraphimosis and balanitis

Question 3. paraphimosis and balanitis.

a. Diagnosis. (1 mark)

• Paraphimosis.

b. Dundee-Perth technique. (4 marks)

• Provide a dorsal penile block, for example bupivacaine 0.25% up to 2 mg/kg.
• Make multiple puncture holes in the oedematous foreskin with a sterile needle.
• Compress the foreskin to express oedema fluid.
• Reduce the foreskin back over the glans.

c. Alternative reduction technique. (5 marks)

• Hold the penis with gauze.
• Grip proximal to the glans.
• Apply steady pressure to the swollen glans/foreskin.
• Maintain firm traction on the foreskin while reducing the glans.
• Continue sustained pressure and traction for several minutes.
• If unsuccessful, seek urgent surgical/urology help.

d. Balanitis treatment. (3 marks)

• Topical 1% lignocaine.
• Topical 1% hydrocortisone.
• Add topical antifungal therapy if Candida is suspected.
• Warm baths and gentle foreskin retraction if possible.
• If recurrent, refer to urology for consideration of circumcision.