Since we first used the Dundee technique in 1996, we have not had to perform a dorsal slit in any patient (Reynard and Barua 1999). We have used this method of reduction in cases where the paraphimosis had been present for a week. Approximately one third of patients underwent elective circumcision for an underlying phimosis.
If this method fails to reduce the paraphimosis, then recourse to the traditional surgical treatment of a dorsal slit is required, usually under general anaesthetic or ring block. Make an incision in the tight band of constricting tissue. Pull the foreskin back over the glan, checking that it can move easily over the glans. If you make a longitudinal incision, this may be closed transversely, so essentially lengthening the circumference of the
6. SCROTAL AND GENITAL EMERGENCIES 137
Figure 6.5. A case of paraphimosis undergoing reduction by the Dundee technique. (See this figure in full color in the insert.)
Figure 6.6. A dorsal slit with the longitudinal incision closed transversely.
foreskin, and hopefully preventing further recurrences of the paraphimosis (Fig. 6.6).
If, having had a dorsal slit, the patient is concerned about the cosmetic appearance, or if the underlying cause of the paraphi-mosis was a phimosis, then he may undergo circumcision at a
138 J. REYNARD AND H. HASHIM
later date. We have avoided immediate circumcision in such cases, because the gross distortion of the normal anatomy of the foreskin can make circumcision difficult and lead to a less than perfect cosmetic result.
FOREIGN BODIES IN THE URETHRA AND ATTACHED TO THE PENIS
All manner of foreign bodies have been inserted into the urethra and bladder either voluntarily, by accident, or as a consequence of assault (van Ophoven and deKernion 2000). Most 'find' their way into the urethra or bladder in the search for sexual gratification. Occasionally elderly patients with dementia insert objects into their urethra and from time to time catheters and endo-scopic equipment (e.g., the insulated tip of a resectoscope) may be 'lost' within the urethra or bladder.