An elderly man develops acute swelling of the penis with a tight constricting band of oedematous foreskin behind the corona after catheterisation, during which the prepuce was left retracted. Manual reduction fails despite adequate lubrication and firm compression of the glans. What is the most appropriate next step?

• A Incision and drainage of the penile shaft skin
• B Immediate formal circumcision
• C Topical steroid cream and review in one week
• D Dorsal slit of the constricting band under local anaesthesia ✓

Explanation

This is paraphimosis, a urological emergency because prolonged constriction causes venous congestion, arterial compromise, and gangrene of the glans. After failed manual reduction, a dorsal slit of the constricting ring relieves the entrapment urgently. Formal circumcision should not be done in the acute swollen phase because tissue viability is uncertain, and it can be performed electively later once oedema settles. Steroids delay decompression, and the pathology is at the preputial ring, not the shaft skin.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.