Trick of the Trade: Paraphimosis – Pour Some Sugar On Me

Paraphimosis occurs when a retracted foreskin can’t be reduced back over the glans of the penis. Risk factors for paraphimosis include scarring, vigorous sexual activity, chronic balanoposthitis, and forgetting to replace the foreskin after catheterization or manipulation.

Paraphimosis can be a urological emergency as the tight ring formed by the foreskin can cause ischemia to the tip of the penis and eventually gangrene. Timely reduction is of high importance. Treatment involves gentle compression of the glans and gradual manual foreskin retraction.¹ Unfortunately, as time goes on, more swelling occurs making traditional reduction techniques more difficult.

Trick of the Trade

Sugar solution for non-reducible paraphimosis

1. Mix 50 mL of 50% dextrose solution with 2% lidocaine jelly (a.k.a. Urojet®).
2. Place a gauze into the solution.
3. Place soaked gauze on the glans of penis.
4. Cover with condom or condom foley.
5. Wait 1 hour.
6. Reduce the paraphimosis.

The high solute concentration of the sugar water pulls the water from the swollen tissue while lidocaine provides topical analgesia. This technique has been described on ALiEM for a case of rectal prolapse and in a 1998 case report.²

Discussion

This may be an easy and cost-effective means of reducing a paraphimosis in the emergency department. The downside is that the treatment requires at least an hour for the swelling to come down. In a letter describing this technique, Dr. Coutts writes his recipe: “a degree of patience on behalf of the surgeon and patient.”³ This trick of the trade worked for our patient who was able to avoid more invasive procedures like a dorsal penile block and a dorsal slit incision.

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