(包茎で亀頭露出から戻れない状態)嵌頓包茎

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2018/08/17 13:19:28」(JST)

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Paraphimosis is an uncommon^[3] medical condition in which the foreskin of a penis becomes trapped behind the glans penis, and cannot be reduced (pulled back to its normal flaccid position covering the glans). If this condition persists for several hours or there is any sign of a lack of blood flow, paraphimosis should be treated as a medical emergency, as it can result in gangrene.^[3]^[4]^[5]

Causes

Paraphimosis is usually caused by medical professionals or parents who handle the foreskin improperly:^[3]^[5] The foreskin may be retracted during penile examination, penile cleaning, urethral catheterization, or cystoscopy; if the foreskin is left retracted for a long period, some of the foreskin tissue may become edematous (swollen with fluid), which makes subsequent reduction of the foreskin difficult.^{[citation needed]}

Prevention and treatment

Paraphimosis can be avoided by bringing the foreskin back into its normal, forward, non-retracted position after retraction is no longer necessary (for instance, after cleaning the glans penis or placing a Foley catheter). Phimosis (both pathologic and normal childhood physiologic forms) is a risk factor for paraphimosis;^[4] physiologic phimosis resolves naturally as a child matures, but it may be advisable to treat pathologic phimosis via long-term stretching or elective surgical techniques (such as preputioplasty to loosen the preputial orifice or circumcision to amputate the foreskin tissue partially or completely).^{[citation needed]}

The foreskin responds to the application of tension to cause expansion by creating new skin cells though the process of mitosis. The tissue expansion is permanent. Non-surgical stretching of the foreskin may be used to widen a narrow, non-retractable foreskin.^[6] Stretching may be combined with the use of a steroid cream.^[7]^[8] Beaugé recommends manual stretching for young males in preference to circumcision as a treatment for non-retractile foreskin because of the preservation of sexual sensation.^[9]

Paraphimosis can often be effectively treated by manual manipulation of the swollen foreskin tissue. This involves compressing the glans and moving the foreskin back to its normal position, perhaps with the aid of a lubricant, cold compression, and local anesthesia as necessary. If this fails, the tight edematous band of tissue can be relieved surgically with a dorsal slit^[3]^[5] or circumcision.^[10]^[11]^[12]^[13]^[14] An alternative method, the Dundee technique, entails placing multiple punctures in the swollen foreskin with a fine needle, and then expressing the edema fluid by manual pressure.^[11] According to Ghory and Sharma, treatment by circumcision may be elected as "a last resort, to be performed by a urologist".^[15] Other experts recommend delaying elective circumcision until after paraphimosis has been resolved.^[3]

References

^ OED 2nd edition, 1989 as /ˌpærəfaɪˈməʊsɪs/.
^ Entry "paraphimosis" in Merriam-Webster Online Dictionary.
^ ^a ^b ^c ^d ^e Jeffrey M Donohoe; Jason O Burnette; James A Brown (October 7, 2009). "Paraphimosis". eMedicine. Patients with severe paraphimosis that proves refractory to conservative therapy will require a bedside emergency dorsal slit procedure to save the penis. A formal circumcision can be performed in the operating room at a later date... At a later date, a formal circumcision can be performed as an outpatient procedure.
^ ^a ^b Hina Z Ghory; Rahul Sharma (April 28, 2010). "Phimosis and Paraphimosis". eMedicine. Patients with phimosis, both physiologic and pathologic, are at risk for developing paraphimosis when the foreskin is forcibly retracted past the glans and/or the patient or caretaker forgets to replace the foreskin after retraction.
^ ^a ^b ^c Choe JM (2000). "Paraphimosis: Current Treatment Options". American Family Physician. 62 (12): 2623–6, 2628. PMID 11142469. If a severely constricting band of tissue precludes all forms of conservative or minimally invasive therapy, an emergency dorsal slit should be performed. This procedure should be performed with the use of a local anesthetic by a physician experienced with the technique... Circumcision, a definitive therapy, should be performed at a later date to prevent recurrent episodes, regardless of the method of reduction used.
^ Dunn HP. Non-surgical management of phimosis. Aust N Z J Surg. 1989;59(12):963. doi:10.1111/j.1445-2197.1989.tb07640.x. PMID 2597103.
^ Zampieri N, Corroppolo M, Giacomello L, et al.. Phimosis: Stretching methods with or without application of topical steroids?. J Pediatr. 2005;147(5):705-6. doi:10.1016/j.jpeds.2005.07.017. PMID 16291369.
^ Ghysel C, Vander Eeckt K, Bogaert GA.. Long-term efficiency of skin stretching and a topical corticoid cream application for unretractable foreskin and phimosis in prepubertal boys. Urol Int. 2009;82(1):81-8. doi:10.1159/000176031. PMID 19172103.
^ Beaugé M. The causes of adolescent phimosis. Br J Sex Med. 1997;(September–October):26.
^ Richard A Santucci; Ryan P Terlecki (April 15, 2009). "Phimosis, Adult Circumcision, and Buried Penis". eMedicine. Reduction of the foreskin under sedation is almost always possible. However, in some situations, a dorsal slit or circumcision is required
^ ^a ^b to be 5Reynard JM, Barua JM. Reduction of paraphimosis the simple way - the Dundee technique. BJU Int. 1999;83(7):859-60. doi:10.1046/j.1464-410x.1999.00119.x. PMID 10368214.
^ Surgical care at the district hospital. World Health Organization. 2003. pp. 9–10. ISBN 92-4-154575-5.
^ Latha Ganti Stead; S. Matthew Stead; Matthew S. Kaufman (2006). First Aid for the Emergency Medicine Clerkship. p. 231. ISBN 0-07-144873-X.
^ Stephen Zderic; Natalie Platcher; Jennifer Kirk (2008). Pediatric Urology for the Primary Care Provider. p. 80. ISBN 1-55642-785-9.
^ Hina Z Ghory; Rahul Sharma (April 28, 2010). "Phimosis and Paraphimosis". eMedicine.

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1. 嵌頓包茎：定義、病態生理、および臨床的特徴 paraphimosis definition pathophysiology and clinical features
2. 嵌頓包茎整復術 paraphimosis reduction
3. 成人における亀頭炎および亀頭包皮炎 balanitis and balanoposthitis in adults
4. 包皮非切除者の陰茎のケア care of the uncircumcised penis
5. 小児における亀頭包皮炎：疫学および病因 balanoposthitis in children epidemiology and pathogenesis

English Journal

Prevalence of preoperative penile abnormalities among voluntary male medical circumcision patients in Swaziland.

Oddo AR1, Ruedrich E2, Zust C3, Marugg L4, VanderWal E5, VanderWal H5, Sartori R6, Markert R7, McCarthy MC8.
Journal of pediatric surgery.J Pediatr Surg.2017 Jan 3. pii: S0022-3468(16)30701-1. doi: 10.1016/j.jpedsurg.2016.12.027. [Epub ahead of print]
BACKGROUND: Circumcision has been found to be an effective strategy for lowering the transmission of HIV in Africa. The Luke Commission, a mobile hospital outreach program, has used this information to decrease the rate of HIV in Swaziland by performing voluntary male medical circumcisions throughou
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The clinical spectrum of syphilitic balanitis of Follmann: report of five cases and a review of the literature.

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Journal of the European Academy of Dermatology and Venereology : JEADV.J Eur Acad Dermatol Venereol.2016 Oct;30(10):1810-1813. doi: 10.1111/jdv.13802. Epub 2016 Jul 16.
BACKGROUND: Eugène Follmann first described syphilitic balanitis as a manifestation of primary syphilis in 1948 and since then it has been known as syphilitic balanitis of Follmann (SBF). So far, SBF has rarely been described in literature.OBJECTIVES: We are reporting five additional cases of SBF c
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Newborn Male Circumcision with Parental Consent, as Stated in the AAP Circumcision Policy Statement, Is Both Legal and Ethical.

Brady MT1.
The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics.J Law Med Ethics.2016 Jun;44(2):256-62. doi: 10.1177/1073110516654119.
Newborn male circumcision is a minor surgical procedure that has generated significant controversy. Accumulating evidence supports significant health benefits, most notably reductions in urinary tract infections, acquisition of HIV and a number of other sexually transmitted infections, penile cancer
PMID 27338601