Search Our Scientific Publications & Authors

Med Clin North Am 2018 Mar 20;102(2):373-385. Epub 2017 Dec 20.

Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue 16-703, Chicago, IL 60611, USA. Electronic address:

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. Read More

Am J Emerg Med 2017 Oct 11;35(10):1391-1395. Epub 2017 Apr 11.

Division of Pediatric Emergency Medicine, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.

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. Read More

J Spec Oper Med Spring 2017;17(1):9-13

Paraphimosis is a urologic emergency resulting in tissue necrosis and partial amputation, if not reduced. Paraphimosis occurs when the foreskin of the uncircumcised or partially circumcised male is retracted behind the glans penis, develops venous and lymphatic congestion, and cannot be returned to its normal position. Invasive reduction of paraphimosis requires minimal instruments and can be accomplished by experienced providers. Read More

J Obstet Gynaecol 2015 11;35(7):768. Epub 2015 Feb 11.

a Department of Obstetrics and Gynaecology , Government Medical College and Hospital , Sector-32, Chandigarh , India.

Am J Emerg Med 2015 Jun 26;33(6):863.e3-5. Epub 2014 Dec 26.

Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA; Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA.

Adequate anesthesia for emergency department management of painful penile conditions such as paraphimosis or priapism is often both technically challenging and inconsistent using traditional landmark-based techniques of the dorsal penile block (DPB). The pudendal nerves branch to form the paired dorsal nerves of the penis providing sensory innervation to the skin of both the dorsal and ventral aspects of the penis. "Blind" DPB techniques tend to rely on subtle tactile feedback from the needle and visual landmark approximation to identify the appropriate subpubic fascial compartment for injection. Read More

Ann R Coll Surg Engl 2014 Mar;96(2):168

Calderdale and Huddersfield NHS Foundation Trust, UK.

J Obstet Gynaecol 2014 Apr 31;34(3):282-3. Epub 2014 Jan 31.

Department of Obstetrics and Gynaecology, Royal Bournemouth and Christchurch Hospitals , Bournemouth , UK.

CJEM 2013 Jul;15(4):241-8

Objective: This study sought to establish the current state of procedural skills training in Canadian Royal College emergency medicine (EM) residencies.

Methods: A national Web-based survey was administered to residents and program directors of all 13 Canadian-accredited Royal College EM residency programs. Program directors rated the importance and experience required for competence of 45 EM procedural skills. Read More

N Engl J Med 2013 Mar;368(13):e16

Geneva University Hospitals, Geneva.

Urol Int 2013 19;90(1):106-8. Epub 2012 Dec 19.

Department of Urology, Government Medical College Hospital, Jammu, India. ananddrajay @ rediffmail.com

Introduction: Paraphimosis is a urologic emergency. Many treatment options have been devised for managing this entity. The osmotic method is one of them. Read More

J Pediatr Urol 2013 Feb 22;9(1):104-7. Epub 2012 Jul 22.

University of Colorado Denver, Anschutz Medical Campus, Division of Urology, 12631 E. 17th Ave., MS 319 Aurora, CO 80045, USA.

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. Read More

J Surg Educ 2012 Jul-Aug;69(4):447-8. Epub 2012 Jan 25.

Department of Urology, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, North Wales, United Kingdom.

Background: Adult circumcision is an extremely common surgical operation. As such, we developed a simple model to teach junior doctors the various techniques of circumcision in a safe, reliable, and realistic manner.

Materials And Methods: A commonly available simulated model penis (Pharmabotics, Limited, Winchester, United Kingdom) is used, which is then covered with a 30-mm diameter, 400-mm long, double-layered simulated bowel (Limbs & Things, Bristol, United Kingdom). Read More

BMC Pediatr 2012 Feb 28;12:20. Epub 2012 Feb 28.

School of Medical Sciences, University of Sydney, Sydney, NSW 2006, Australia.

Background: Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves.

Discussion: We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. Read More

ScientificWorldJournal 2011 Feb 3;11:289-301. Epub 2011 Feb 3.

Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Japan.

Phimosis is a condition in which the prepuce cannot be retracted over the glans penis. Actually, physiologic phimosis is common in male patients up to 3 years of age, but often extends into older age groups. Balanoposthitisis a common inflammation occurring in 4-11% of uncircumcised boys. Read More

West J Emerg Med 2009 Nov;10(4):281-7

Jesse Brown VA Medical Center, Department of Emergency Medicine, Chicago, IL.

Although true urologic emergencies are extremely rare, they are a vital part of any emergency physician's (EP) knowledge base, as delays in treatment lead to permanent damage. The four urologic emergencies discussed are priapism, paraphimosis, testicular torsion, and Fournier's gangrene. An overview is given for each, including causes, pathophysiology, diagnosis, treatment, and new developments. Read More

Int Urol Nephrol 2006 ;38(1):111-3

Solent Department of Urology, St Mary's Hospital, Portsmouth, England.

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. Read More

Int J Clin Pract 2005 May;59(5):591-3

Department of Urology, Gartnaval Hospital, Glasgow, UK.

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. Read More

Emerg Med J 2004 Jan;21(1):77-8

Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.

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. Read More

Actas Urol Esp 2001 May;25(5):393-5

Centro de Salud de Sarriá, Lugo.

Purpose: To evaluate the effectivity of granulated sugar in the treatment of irreductable paraphimosis.

Clinical Cases: During last year three patients have been treated by application of granulated sugar on prepuce and glands penis during 1-2 hours until edema reduction was observed. Paraphimosis could be reducted in all three cases. Read More

BJU Int 2001 Aug;88(3):305

Ann R Coll Surg Engl 2001 Mar;83(2):126-7

Department of Urology, Leighton Hospital, Crewe, Cheshire, UK.

Patients And Methods: A total of 45 patients underwent reduction of paraphymosis at LN Hospital, Delhi, India and Leighton Hospital, Crewe, UK from August 1991 to September 1999 using the multiple puncture and glans squeeze technique. These were divided into 3 grades: grade 1, paraphymosis without engorgement of glans; grade 2, paraphymosis with engorgement of glans; and grade 3, paraphymosis with associated skin changes (non-pitting oedema, cheese-cutting of the shaft of the penis or erosions).

Results: Grade 1 (6) patients were reduced by simply pulling the foreskin back into the normal position. Read More

Am Fam Physician 2000 Dec;62(12):2623-6, 2628

University of Cincinnati Medical Center, Ohio, USA.

Paraphimosis is a urologic emergency, occurring in uncircumcised males, in which the foreskin becomes trapped behind the corona and forms a tight band of constricting tissue. Often iatrogenically induced, paraphimosis can be prevented by returning the prepuce to cover the glans following penile manipulation. Treatment often begins with reduction of edema, followed by a variety of options, including mechanical compression, pharmacologic therapy, puncture technique and dorsal slit. Read More

BJU Int 1999 Nov;84(7):890-1

Urology 1999 Nov;54(5):917-8

Department of Surgery, University of Chicago, Pritzker School of Medicine, Illinois, USA.

Reduction of paraphimosis can be a painful and difficult process. Methods thus far proposed focus on decreasing the edema before reduction. We have used the basic surgical principle of traction and countertraction by applying a pair of Adson forceps directly to the band formed by the retracted preputial opening. Read More

BJU Int 1999 Feb;83(3):362

BJU Int 1999 May;83(7):859-60

Department of Urology, The Churchill Hospital, Oxford, UK.

Br J Urol 1998 Nov;82(5):755

Department of Surgery, Royal Gwent Hospital, Newport, UK.

Urology 1997 Jul;50(1):160

Arch Pediatr Adolesc Med 1997 Mar;151(3):315-316

A 2½year-old boy had the onset of pain and swelling of his penis during the past 3 days. The swelling and pain increased significantly within the past 24 hours. The child's penis is shown in the Figure. Read More

Pediatr Emerg Care 1996 Oct;12(5):336-9

Department of Pediatrics, Egleston Children's Hospital, Emory University School of Medicine, Atlanta, GA 30322, USA.

Objective: To survey a cohort of physicians who work in general community emergency departments (ED) in order to assess their comfort levels in performing urgent and emergent medical procedures on children.

Methods: One hundred seventeen emergency physicians were surveyed at 23 institutions within the referral base of Hasbro Children's Hospital, a tertiary care pediatric ED. Physicians rated their comfort levels (4-point scale: 1 = comfortable, 2 = moderately comfortable, 3 = uncomfortable but would perform in an emergency, 4 = uncomfortable and would never perform) for all procedures in which the American Academy of Pediatrics recommends competence for pediatric emergency physicians. Read More

Br J Surg 1996 Sep;83(9):1247

Department of Surgery, Veer Surendra Sai Medical College, Burla, India.

Urology 1996 Sep;48(3):464-5

Medical College of Georgia, Augusta 30912, USA.

The use of hyaluronidase facilitates reduction of paraphimosis. It acts by dispersing extracellular edema, permitting easy reduction of the foreskin. Its use is applicable both in the hospital and outpatient setting. Read More

Am J Emerg Med 1995 May;13(3):351-3

Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.

Paraphimosis occurs when the foreskin of the penis is retracted over the glans and cannot be replaced in its normal position. The tight ring of preputial skin constricts the distal penis causing vascular occlusion, much like a tourniquet. The condition is painful and, if not dealt with quickly, can lead to necrosis of the glans. Read More

Eur J Pediatr Surg 1994 Dec;4(6):370-1

Department of Paediatric Surgery, St. Jame's University Hospital, Leeds, UK.

Paraphimosis in uncircumcised or incompletely circumcised children is a serious and painful condition requiring prompt reduction to prevent possible necrosis of the glans or urinary obstruction. Techniques described to reduce oedema distal to the constricting ring include application of ice packs, compressive elastic bandages, and making a dorsal slit which necessitates later circumcision. We have used a simple "puncture" technique to treat successfully an uncircumcised 12-year-old boy with severe paraphimosis. Read More

Pediatr Emerg Care 1993 Oct;9(5):298-9

Division of Urology/Section of Pediatric Urology, Robert Wood Johnson Medical School, New Brunswick, New Jersey.

The puncture technique is a simple method that aids in the manual reduction of the paraphimotic foreskin. We present a case that describes how we are currently using the technique in our pediatric patients. Read More

Br J Urol 1992 Feb;69(2):220

Br J Urol 1990 Dec;66(6):666

Department of Surgery, Princess Margaret Hospital for Children, Perth, Australia.

Hautarzt 1989 Jul;40(7):434-6

Universitätsklinik für Dermatologie und Venerologie, Innsbruck.

A hypervascularization syndrome following arterialization of the deep dorsal vein of the penis to amend venous erectile impotence is a rare cause of penile ulcers that has not previously been described in the dermatological literature. Arterialization is performed by installing a shunt from the inferior epigastric artery or a venous bypass from the femoral artery to the deep dorsal vein of the penis, resulting in a blockage of venous outflow and in retrograde inflow into the corpora cavernosa. Complications arise as a result of persistently elevated blood pressure in the deep venous system and the erectile tissue in 10-20% of cases and are most often linked to dilatation of the shunt: the consequences are enlargement and induration of the glans, hazard of phimosis and paraphimosis, pulsation of the penis, micturation difficulties and, ultimately, ulceration of the glans. Read More

Urology 1985 Mar;25(3):337

Urology 1985 Jan;25(1):77

J Urol 1970 Jul;104(1):137

J Urol 1954 Apr;71(4):450