Ice, pins or sugar to reduce paraphimosis
Date First Published:
February 18, 2003
Last Updated:
January 21, 2004
Report by:
Kevin Mackway-Jones, Consultant (Manchester Royal Infirmary)
Search checked by:
Stewart Teece, Manchester Royal Infirmary
Three-Part Question:
In [an adult male with irreducible paraphimosis] is [ice better than multiple puncturing or sugar] at [reducing swelling and allowing reduction]?
Clinical Scenario:
You are asked to see a 19 year old man who has presented to the Emergency Department with paraphymosis. He states that he fell asleep after sex the night before and woke up with swelling. Simple traction has failed to cure the problem (but has brought tears to his eyes). A surgeon, a specialist registrar in emergency medicine and a urologist are already in attendance. The first says that multiple punctures should be made with a needle, the second that an iced glove should be used and the third that sugar should be applied. You wonder whether any of the suggested methods are evidence-based.
Search Strategy:
Medlilne 1966-10/03 using the OVID interface.
Search Details:
[paraphymosis.mp OR paraphimosis.mp OR exp paraphimosis OR (foreskin.mp AND retraction.mp)] AND [reduc$.mp OR exp ice OR ice$.mp OR puncture$.mp OR exp punctures OR sugar.mp]
Outcome:
Altogether 33 papers found, of which 3 were relevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Sugar: treatment of choice in irreducible paraphimosis. Gonzalez FM, Sousa EMA, Parra ML. 2001, Spain | 3 patients with paraphimosis Application of granulated sugar for 1-2hr |
Case series | Reduction | All reduced | Small numbers No controls |
| Modified puncture technique for reduction of paraphymosis. Kumar V, Javle P. 2001, UK and India | 45 patients with paraphimosis Multiple puncture in patients with glans engorgement (39) |
Case series | Reduction | All reduced if no skin changes | Small numbers No controls |
| The "iced-glove" method of treatment of paraphimosis. Houghton GR. 1973, England | 10 patients with paraphimosis aged 8 – 91 years. Iced glove placed for 5 minutes |
Case series | Reduction | 9 out of 10 | Small numbers No controls |
Author Commentary:
There are no comparative or randomised trials in this area. Current treatment is based wholly on custom, practice and word of mouth. Further research is warranted.
Bottom Line:
All three methods have been shown to work, but there is no evidence to show which is best. Local guidelines should be followed.
References:
- Gonzalez FM, Sousa EMA, Parra ML.. Sugar: treatment of choice in irreducible paraphimosis.
- Kumar V, Javle P.. Modified puncture technique for reduction of paraphymosis.
- Houghton GR.. The "iced-glove" method of treatment of paraphimosis.