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16 Phimosis & Paraphimosis, all pt w/ this require emergency reduction…
16 Phimosis & Paraphimosis
Phimosis包茎
Clinical manifestations
non-retractable foreskin
signs of infection: due to ineffective cleaning (e.g. swelling, redness, purulent discharge脓性分泌物, pain)
dysuria 排尿困难
decreased urinary flow (if stenosis狭窄 of the urinary meatus尿道 develops) -> need to strain拉紧 to void
Complications
penile carcinoma 阴茎癌
urinary retention 尿潴留
balanitis 龟头炎
Etiology
Congenital
先天:
the foreskin is tight, non-retractable & adherent to the glands
at birth*
normal for some young children, does not cause problems (e.g. urinary obstruction, hematuria血尿, preputial pain包皮痛
Acquired
后天:
poor hygiene
chronic balanoposthitis龟头包皮炎: inflammation of the foreskin & glans in uncircumcised male
catheterization
forceful retraction of a congenital phimosis in an attempt to clean the glans
Management
Medical
antibiotic therapy
for infections
warm soaks
tropical creams:
steroidal & non steroidal, applied to the prepuce
Surgical
Circumcision割礼
needed
if presence of
hematuria/pain
A dorsal slit of the foreskin
as emergency measure
if
obstruction to urination
def: A condition of the penis in which the
foreskin包皮 is too tight to be retracted缩回
and
reveal the glans龟头/head of the penis
Nursing Management
1)
Post Circumcision Care
monitoring urine output, assess for oliguria少尿
providing pain control
assess the penis for change in color for circulation
2)
Patient Education
penile hygiene阴茎卫生: cleaning under the foreskin
always return the foreskin to cover the glans after cleaning
Paraphimosis包茎
Complications
Gangrene of the glans
Posthitis包皮炎 (inflammation of the prepuce)
Management
Medical
Manual reduction
penis is elevated & cool compress applied to decrease edema prior the procedure
using local anesthetic, penis is squeeze with a gloved hand for 5 mins to try to reduce size of glans
glans is pushed while the foreskin is pulled down over it
Injection of hyaluronidase 透明质酸酶: to reduce edema
Surgical
Circumcision
recommended for recurrence (after inflammation & edema subside) by urologist
Clinical manifestations
edema, tenderness, erythema of the glans
edema of the distal foreskin
bluish glans青色的龟头 due to impaired blood supply
flaccidity软弱无力 (weak muscle tone) of the penile shaft proximal to the area of paraphimosis
pain on erection勃起
Etiology
Urinary catheterization
most common
(after inserting the catheter, failure to replace the foreskin over glans after the procedure)
A tight prepuce
cause swelling
when it is retracted
Chronic balanoposthitis (scar tissue under foreskin inhibits its flexibility)
Penile piercing阴茎穿孔
Nursing management
administer narcotic analgesic 麻醉镇痛药 if ordered before manual reduction
instruct client to elevate the penis & to apply cool compresses (to reduce edema)
after reduction of the foreskin, get client to void
advise pt to wear loose pants after surgery
if circumcision is not performed, emphasize the importance of penile hygiene
def: a condition in which the
foreskin is retracted behind the glans
and
cannot be returned
to its original position, causing the venous & lymphatic return from the gland and distal foreskin is obstructed
causing edema & pain
all pt w/ this require emergency reduction