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swollen penis that is of an acute onset. What is your diagnosis? a. Paraphimosis b. Amniotic band syndrome c. Angioneurotic edema d. Balanoposthitis. Answer.
PHOTO CLINIC Brief Photo-Based Cases

Painful and Swollen Penis Alexander K.C. Leung, MBBS, FRCPC, FRCP (UK&Irel), FRCPCH

A 12-year-old boy presents with a painful and swollen penis that is of an acute onset.

What is your diagnosis? a. b. c. d.

Paraphimosis Amniotic band syndrome Angioneurotic edema Balanoposthitis

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an se rs c onal u e s u Answer rs ised for pe r o h y Aut le cop Paraphimosis (answer a) develops when a phimot. d te sing ibipenis ic foreskin is retracted behind the headrof a ohthe p int and becomes trapped. When d paraphimosis use and pisr seen Figure 1: Painful and Swollen Penis w foreskin has rise viethe in children, it is often hobecause t , u y a a l n Uncircumcised males are at higher risk of been forcefully U retracted disp or the foreskin is not

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reduced after voiding or bathing. The constricting band proximal to the swelling is pathognomonic. The constricting ring impairs the lymphatic and blood flow to and from the glans and foreskin. Lymphatic and venous stasis develops, with resultant pain and swelling of the foreskin. Paraphimosis is a pediatric urologic emergency. If paraphimosis is not treated early, penile ischemia and gangrene may develop. Manual reduction of the foreskin with appropriate lubrication is usually successful. If the foreskin cannot be reduced forward, a dorsal preputial slit may be required.

developing paraphimosis than circumcised males. Children with phimosis may require treatment with a topical hydrocortisone cream. Circumcision should be considered if topical treatment with hydrocortisone cream is not successful. Alexander K.C. Leung, MBBS, FRCPC,

FRCP

(UK&Irel), FRCPCH, is a Clinical Professor of Pediatrics, at the University of Calgary, Calgary, Alberta. Carmen Fong is a medical student at the University of Calgary, Calgary, Alberta.

The Canadian Journal of CME / June 2011 9