Page 31 - Journal of Special Operations Medicine - Spring 2017

Invasive Reduction of Paraphimosis in an Adolescent Male
While in a Deployed Austere Environment

Christopher K. Pham, DO; Joseph Zehring, EMT-B;
Cristóbal S. Berry-Cabán, PhD

ABSTRACT

Paraphimosis is a urologic emergency resulting in tissue deployed in an austere region of Africa (Figures 1 and
necrosis and partial amputation, if not reduced. Para- 2). Paraphimosis occurred 10 days earlier when the
phimosis occurs when the foreskin of the uncircumcised patient manually retracted his foreskin to urinate and
or partially circumcised male is retracted behind the failed to reduce his foreskin. It is unclear why he did not
glans penis, develops venous and lymphatic congestion, reduce his foreskin. The patient began having increased
and cannot be returned to its normal position. Invasive pain and edema of his distal shaft and glans penis in
reduction of paraphimosis requires minimal instruments subsequent days. The patient’s mother made an unsuc-
and can be accomplished by experienced providers. This cessful manual attempt at reducing his paraphimosis.
case describes a 10-year-old local national with paraphi- The patient could urinate with some discomfort at the
mosis over 10 days that required invasive reduction in a site of edema.
deployed austere environment in Africa.
Figure 1 Paraphimosis of a 10-year-old African local national.
Keywords: paraphimosis; penile diseases; penis; foreskin;
treatment

Introduction
Paraphimosis occurs when the foreskin of an uncircum-
cised or partially circumcised male is in a fixed retracted
position causing venous constriction. Replacing the fore-
skin to its anatomic position is paramount for resolving
paraphimosis. The inability to reduce the foreskin back
to normal anatomy can lead to edema, ischemia, and Figure 2 Paraphimosis of a 10-year-old African local national.
serious complications such as tissue necrosis, gangrene,
and amputation. The urgency for intervention varies:
1
some patients exhibit signs of ischemia within a few
hours of onset and others present minimal compromise
with a few days of symptoms. This condition requires
2
prompt urologic consultation for evaluation and treat-
ment. However, military medical providers often find
themselves in an austere environment lacking such sup-
port. The following report discusses a case that required
multiple methods of paraphimosis reduction, including
invasive techniques.

The patient’s mother sought medical care on day 8 from
Case Report
a local hospital clinician who then consulted a co-lo-
A 10-year-old, uncircumcised local national presented cated partnered force 2 days later. Reduction was not
with paraphimosis to the Special Operations Resusci- performed at that time because of lack of knowledge
tation Team (SORT), a US Army Special Operations of the condition and supply of analgesics of the local
Command nonsurgical Role II medical support team clinicians and partnered force providers. Additionally,

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