ABSTRACT
Selected emergency conditions of male and female reproductive tracts in horses are described, including injuries affecting the external genitalia of male horses and emergent conditions arising during gestation in mares. Conditions affecting male horses are discussed in the context of breeding stallions, but kicks or other mechanisms of trauma in the groin can also affect geldings. Priapism, paraphimosis, trauma to the scrotum and testicles, and penile injury are discussed. In mares, traumatic vestibular injury, placentitis, hydropsic conditions, prepubic tendon and abdominal wall compromise, and uterine torsion are included. Clinical recognition of the problem, diagnostic procedures, and treatments are summarized.
Subject(s)
Horse Diseases/diagnosis , Paraphimosis/veterinary , Priapism/veterinary , Reproduction , Animals , Breeding , Emergencies/veterinary , Female , Genitalia, Female/injuries , Genitalia, Male/injuries , Horse Diseases/therapy , Horses , Male , Paraphimosis/diagnosis , Paraphimosis/therapy , Pregnancy , Priapism/diagnosis , Priapism/therapy , Wounds and Injuries/veterinaryABSTRACT
Urologic Emergencies: Paraphimosis Abstract. Paraphimosis presents a rare but acute urological emergency whereby the foreskin becomes entrapped behind the coronary sulcus of the penis. Therapy is quick and feasible, even in an outpatient setting. In most cases compression of the preputial edema and subsequent reposition of the prepuce is sufficient. Rarely, surgical intervention in form of a dorsal incision of the constriction is required. With partial or full phimosis being the underlying condition, paraphimosis occurs predominantly in infants and toddlers. However, persistent or secondary phimosis can lead to paraphimosis in advanced age.
Subject(s)
Paraphimosis/diagnosis , Paraphimosis/surgery , Paraphimosis/therapy , Phimosis , Child, Preschool , Emergencies , Emergency Service, Hospital , Humans , MaleABSTRACT
The penis is an organ of enormous importance and is vital for both excretory and reproductive function. The anatomy of the penis itself can lead to many of its emergent conditions and a thorough understanding of the anatomy and physiology is central to recognition of these conditions. Physicians should have a high clinical suspicion for penile emergencies and perform a thorough physical examination to make a proper diagnosis. Prompt diagnosis and proper management are essential for minimizing dysfunction of this vital organ.
Subject(s)
Penile Diseases/diagnosis , Emergencies , Humans , Male , Paraphimosis/diagnosis , Paraphimosis/therapy , Penile Diseases/therapy , Penis/injuries , Phimosis/diagnosis , Phimosis/therapy , Priapism/diagnosis , Priapism/therapyABSTRACT
Urologic emergencies can involve the kidneys, ureters, bladder, urethra, penis, scrotum, or testicles. History and physical examination are essential to diagnosis, whereas imaging is increasingly used to confirm diagnoses. Acute urinary retention should be relieved with Foley placement. Penile emergencies include paraphimosis, which can be treated by foreskin reduction, whereas penile fracture and priapism require urologic intervention. Fournier gangrene and testicular torsion are scrotal emergencies requiring emergent surgery. Nephrolithiasis, although painful, is not an emergency unless there is concern for concomitant urinary tract infection, both ureters are obstructed by stones, or there is an obstructing stone in a solitary kidney.
Subject(s)
Urologic Diseases/diagnosis , Urologic Diseases/therapy , Acute Disease , Emergencies , Female , Female Urogenital Diseases/diagnosis , Female Urogenital Diseases/therapy , Fournier Gangrene/diagnosis , Fournier Gangrene/therapy , Humans , Male , Male Urogenital Diseases/diagnosis , Male Urogenital Diseases/therapy , Nephrolithiasis/diagnosis , Nephrolithiasis/microbiology , Nephrolithiasis/therapy , Paraphimosis/diagnosis , Paraphimosis/therapy , Penis/injuries , Priapism/diagnosis , Priapism/therapy , Referral and Consultation , Rupture , Spermatic Cord Torsion/diagnosis , Spermatic Cord Torsion/therapy , Urinary Retention/diagnosis , Urinary Retention/therapyABSTRACT
BACKGROUND: Paraphimosis is an acute urologic emergency requiring urgent manual reduction, frequently necessitating procedural sedation (PS) in the pediatric population. The present study sought to compare outcomes among pediatric patients undergoing paraphimosis reduction using a novel topical anesthetic (TA) technique versus PS. METHODS: We performed a retrospective analysis of all patients <18years old, presenting to a tertiary pediatric ED requiring analgesia for paraphimosis reduction between October 2013 and September 2016. The primary outcome was reduction first attempt success; secondary outcomes included Emergency Department length of stay (ED LOS), adverse events and return visits. Dichotomous outcomes were analyzed by Chi-square testing and multivariate linear regression was used to compare continuous variables. RESULTS: Forty-six patients were included; 35 underwent reduction using TA, 11 by PS. Patient age and duration of paraphimosis at ED presentation did not differ between groups. There was no difference in first attempt success between TA (32/35, 91.4%) and PS groups (9/11, 81.8%; p=0.37). Mean ED LOS was 209min shorter for TA patients (148min vs. 357min, p=0.001) and remained significantly shorter after controlling for age and duration of paraphimosis (adjusted mean difference -198min, p=0.003). There were no return visits or major adverse events in either group, however, among successful reduction attempts, PS patients more frequently experienced minor adverse events (7/9 vs. 0/32, p<0.001). CONCLUSIONS: Paraphimosis reduction using TA was safe and effective. Compared to PS, TA was associated with a reduced ED LOS and fewer adverse events. TA could potentially allow more timely reduction with improved patient experience and resource utilization.
Subject(s)
Anesthetics, Intravenous/therapeutic use , Anesthetics, Local/therapeutic use , Emergency Service, Hospital , Hypnotics and Sedatives/therapeutic use , Paraphimosis/therapy , Child , Child, Preschool , Humans , Male , Retrospective Studies , Treatment OutcomeABSTRACT
The diagnosis and management of urologic emergencies are incorporated into the basic training of all urology residents. In institutions without access to urologic services, it is usually left to the General Surgeon or Emergency Medicine physician to provide timely care. This article discusses diagnoses that are important to recognize and treatment that is practically meaningful for the non-Urologist to identify and treat. The non-Urology provider, after reading this article, will have a better understanding and a higher comfort level with treating patients with urologic emergencies.
Subject(s)
Fournier Gangrene/therapy , Paraphimosis/therapy , Priapism/therapy , Pyonephrosis/therapy , Spermatic Cord Torsion/therapy , Urinary Retention/therapy , Acute Disease , Emergency Treatment , Female , Fournier Gangrene/diagnosis , Humans , Male , Paraphimosis/diagnosis , Priapism/diagnosis , Pyonephrosis/diagnosis , Spermatic Cord Torsion/diagnosis , Urinary Retention/diagnosisSubject(s)
Paraphimosis/therapy , Analgesia/methods , Child , Child, Preschool , Conscious Sedation/methods , Humans , Infant , Male , Paraphimosis/diagnosis , Paraphimosis/pathologySubject(s)
Paraphimosis/therapy , Anesthesia, Local , Child , Equipment and Supplies , Humans , Male , Paraphimosis/etiology , Postoperative CareABSTRACT
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.
Subject(s)
Bandages , Edema/therapy , Paraphimosis/therapy , Acute Disease , Adolescent , Child , Child, Preschool , Foreskin , Humans , Male , PenisABSTRACT
Introducción: la parafimosis es frecuente en los servicios de urgencia. Su reducción precoz resulta fácil, pero si los niños asisten tardíamente, puede constituir un problema. Debido a los intentos de reducción infructuosos y dolorosos, estos pacientes sufren gran carga de tensión emocional. Objetivos: describir y mostrar la aplicación de un método práctico de reducción manual sin dolor, en pacientes con parafimosis de largo tiempo de evolución. Métodos: se realizó un estudio longitudinal, prospectivo y descriptivo, de los pacientes tratados (n= 25), con diagnóstico de parafimosis de largo tiempo de evolución (+ 12 horas), en el periodo comprendido entre enero de 2009 y junio de 2011. Se les aplicó un método fundamentado en el bloqueo anestésico anular subcutáneo en la base del pene, derivada de la inervación pudenda. Se seleccionaron variables como edad, causa externa desencadenante, tratamiento conservador inicial, tiempo de demora en asistir para la reducción, y complicaciones. Se procesó la información en frecuencias absolutas y porcentajes, dando como resultado pruebas de significación para su análisis estadístico. Resultados: la manipulación brusca del prepucio por la propia madre, condicionó esta complicación en el 68 porciento de los menores de 5 años. Tratamientos conservadores, motivaron una demora para su reducción significativa, en el 80 porciento de los casos. Conclusiones: este método es bien aceptado por el paciente, le brinda una solución sin dolor, y es de fácil aplicación en los servicios de urgencias. Se evitan procederes más cruentos como la fimotomía(AU)
Introduction: the paraphimosis is frequent in emergence services. Its early reduction is easy, but if children come late it may to be a serious problem. Due to the unsuccessful and painful attempts of reduction, these patients suffer a significant charge of emotional tension. Objectives: to describe and to show the implementation of a practical method of painless manual reduction in patients with a prolonged paraphimosis. Methods: a descriptive, prospective and longitudinal study was conducted in patients treated (25), diagnosed with paraphimosis of long term course (+ 12 hr) from January, 2009 to June, 2011. A method based in the subcutaneous annular anesthetic block was applied in the penis base derived of the pudendal innervation. The following variables were selected: age, triggering external cause, initial conservative treatment, to until reduction and complications. Information was processed in absolute frequency and percentages where the results were significant tests for its statistic analysis. Results: the sudden manipulation of prepuce by mother leads to this complication in the 68 percent of children aged under 5. The conservative treatments caused a significant delay for its reduction in the 80 percent of cases. Conclusions: this method is well accepted by patient giving him a painless solution and it is of easy application in emergence services. Procedures more painful like the phimotomy are avoided(AU)
Subject(s)
Humans , Male , Child , Adolescent , Paraphimosis/physiopathology , Paraphimosis/therapy , Epidemiology, Descriptive , Prospective Studies , Longitudinal StudiesABSTRACT
Introducción: la parafimosis es frecuente en los servicios de urgencia. Su reducción precoz resulta fácil, pero si los niños asisten tardíamente, puede constituir un problema. Debido a los intentos de reducción infructuosos y dolorosos, estos pacientes sufren gran carga de tensión emocional. Objetivos: describir y mostrar la aplicación de un método práctico de reducción manual sin dolor, en pacientes con parafimosis de largo tiempo de evolución. Métodos: se realizó un estudio longitudinal, prospectivo y descriptivo, de los pacientes tratados (n= 25), con diagnóstico de parafimosis de largo tiempo de evolución (+ 12 horas), en el periodo comprendido entre enero de 2009 y junio de 2011. Se les aplicó un método fundamentado en el bloqueo anestésico anular subcutáneo en la base del pene, derivada de la inervación pudenda. Se seleccionaron variables como edad, causa externa desencadenante, tratamiento conservador inicial, tiempo de demora en asistir para la reducción, y complicaciones. Se procesó la información en frecuencias absolutas y porcentajes, dando como resultado pruebas de significación para su análisis estadístico. Resultados: la manipulación brusca del prepucio por la propia madre, condicionó esta complicación en el 68 porciento de los menores de 5 años. Tratamientos conservadores, motivaron una demora para su reducción significativa, en el 80 porciento de los casos. Conclusiones: este método es bien aceptado por el paciente, le brinda una solución sin dolor, y es de fácil aplicación en los servicios de urgencias. Se evitan procederes más cruentos como la fimotomía
Introduction: the paraphimosis is frequent in emergence services. Its early reduction is easy, but if children come late it may to be a serious problem. Due to the unsuccessful and painful attempts of reduction, these patients suffer a significant charge of emotional tension. Objectives: to describe and to show the implementation of a practical method of painless manual reduction in patients with a prolonged paraphimosis. Methods: a descriptive, prospective and longitudinal study was conducted in patients treated (25), diagnosed with paraphimosis of long term course (+ 12 hr) from January, 2009 to June, 2011. A method based in the subcutaneous annular anesthetic block was applied in the penis base derived of the pudendal innervation. The following variables were selected: age, triggering external cause, initial conservative treatment, to until reduction and complications. Information was processed in absolute frequency and percentages where the results were significant tests for its statistic analysis. Results: the sudden manipulation of prepuce by mother leads to this complication in the 68 percent of children aged under 5. The conservative treatments caused a significant delay for its reduction in the 80 percent of cases. Conclusions: this method is well accepted by patient giving him a painless solution and it is of easy application in emergence services. Procedures more painful like the phimotomy are avoided
Subject(s)
Humans , Male , Child , Adolescent , Paraphimosis/physiopathology , Paraphimosis/therapy , Epidemiology, Descriptive , Longitudinal Studies , Prospective StudiesSubject(s)
Horse Diseases/therapy , Paraphimosis/veterinary , Penis/pathology , Wounds and Injuries/veterinary , Animals , Edema/prevention & control , Edema/veterinary , Horse Diseases/pathology , Horses , Male , Paraphimosis/pathology , Paraphimosis/therapy , Physical Examination/veterinary , Wounds and Injuries/pathology , Wounds and Injuries/surgeryABSTRACT
Las urgencias en pediatría siempre han constituido un problema frecuente y, muchas veces, difícil de resolver, ya sea por la poca historia aportada por los padres -lo que es propio de la preocupación y ansiedad de la situación-, como también por la falta de información en relación a algunas maniobras simples que pueden ser realizadas por cualquier médico. Las lesiones genitourinarias suelen desestimarse en una evaluación de urgencia, a pesar de la trascendencia que éstas pudieran tener a futuro, por lo que suelen pesquisarse en una evaluación secundaria, o luego de la aparición de complicaciones. El presente artículo tiene como objetivo dar a conocer los conceptos que componen el manejo de urgencias genitourinarias en cirugía pediátrica, haciendo énfasis en aquellas que ocurren con mayor frecuencia y que implican un riesgo de complicaciones deletéreas, así como también en las que, por simplicidad de maniobras, pueden ser realizadas en cualquier servicio de atención de urgencia. Los temas expuestos son: torsión testicular, torsión de hidátide testicular, parafimosis, lesiones del tracto urinario y atrapamiento de prepucio en cremallera del pantalón.
Subject(s)
Humans , Male , Child , Genital Diseases, Male/diagnosis , Genital Diseases, Male/therapy , Varicocele/diagnosis , Varicocele/therapy , Emergencies , Paraphimosis/therapy , Pediatrics/methods , Penis/injuries , Testis/injuries , Spermatic Cord Torsion/diagnosis , Spermatic Cord Torsion/therapy , Urinary Tract/injuriesSubject(s)
Emergency Nursing/methods , Emergency Treatment/methods , Paraphimosis/therapy , Administration, Cutaneous , Adult , Circumcision, Male , Cryotherapy , Dietary Sucrose/therapeutic use , Drainage , Emergency Treatment/nursing , Humans , Male , Nurse Practitioners , Paraphimosis/diagnosis , Paraphimosis/etiology , Urinary Catheterization/adverse effectsABSTRACT
A 90-year-old man on hormonal treatment for invasive (T4) adenocarcinoma of the prostate presented as an emergency with a paraphimosis secondary to placement of four circumferential key rings around his penis. He had experienced referred penile pain from his prostate cancer, and to overcome this, had attempted to 'gate out' his pain by constricting his penis and thus stimulating the pudendal nerve. His treatment in our unit consisted of a penile local anaesthetic block, removal of the key rings with a ring cutter and manual reduction of the paraphimosis.
Subject(s)
Adenocarcinoma/complications , Neuralgia/etiology , Neuralgia/therapy , Paraphimosis/etiology , Prostatic Neoplasms/complications , Self Care/adverse effects , Aged, 80 and over , Constriction , Humans , Ligation/adverse effects , Male , Paraphimosis/therapyABSTRACT
Paraphimosis is a frequently presented complaint in the emergency department. This review outlines the treatment options available for resolving this condition: manual reduction methods, osmotic methods, puncture and aspiration methods and treatments using sharp incision. The technique of penile block local anaesthesia is described. A technique sequence for treatment is suggested.
Subject(s)
Emergency Treatment/methods , Paraphimosis/therapy , Ambulatory Surgical Procedures , Anesthetics, Local , Humans , Lidocaine , Male , Nerve Block , Paraphimosis/surgerySubject(s)
Coitus , Paraphimosis/etiology , Adult , Humans , Male , Paraphimosis/diagnosis , Paraphimosis/therapyABSTRACT
A short cut review was carried out to establish which of the ice glove technique, the multiple puncture technique, or the application of sugar was the best approach for paraphimosis reduction. Thirty three papers were found using the reported search, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
