What should be done in the ED for paraphimosis?

• A. Observation
• B. Circumcision
• C. Administer antibiotics
• D. Consult Urology

Answer: (D)

Paraphimosis is a urologic emergency where the foreskin is retracted behind the glans and cannot be replaced, leading to edema and possible ischemia if not relieved promptly. The ED goal is to relieve the constriction as quickly as possible. Manual reduction with lubrication and adequate analgesia is the first-line step, and if reduction is not achievable promptly or the edema is severe, urgent urology involvement is required for definitive management, which may include procedures like a dorsal slit or circumcision. Antibiotics aren’t routinely needed unless there’s infection, and observation would delay necessary treatment. Consulting urology ensures timely reduction or surgical intervention as needed.