• • Reduction of retracted, constricting foreskin.

Relative

• • Recent penile surgery.

• • Nonsterile gloves.

  • Ice packs.

  • 2 × 2 or 4 × 4 gauze.

  • Topical anesthetic or buffered 1% lidocaine solution, or both.

• • Failure of reduction (success rates depend on duration of paraphimosis and degree of edema).

  • Psychological stress (common; child is restrained for procedure).

  • Pain (certain; can be limited somewhat with anesthesia).

  • Cold injury.

• • Use gauze to grasp the foreskin.

  • If swelling is pronounced, try manual compression prior to reduction.

  • Timid attempts at reduction in an effort to reduce pain ultimately result in delayed reduction and increased overall pain.

  • If initial attempts are unsuccessful, urgent referral to a urologist is recommended.