QuestionSBA
QuestionChoice
This is a case of paraphimosis, which is a medical emergency as the blood flow to the glans is compromised. It may require surgical decompression if manual decompression fails or is inappropriate. In this case, it likely occurred as the individual who replaced the catheter forgot to replace the foreskin.
10035537
a
Arrange emergency medical admission
QuestionChoice
This is inappropriate as paraphimosis is a medical emergency, given the risk of ischaemia.
10035541
e
Advise this is normal in patients who have long-term catheters
QuestionChoice
This would be useful in the case of bacterial balanitis, which would not present with acute pain or these examination findings.
10035539
c
Prescribe an oral antibiotic
QuestionChoice
This would be useful in the case of fungal balanitis, which would not present with acute pain or these examination findings.
10035538
b
Prescribe a topical antifungal
QuestionChoice
This is inappropriate as this is a medical emergency, which may require circumcision if surgical decompression is needed.
10035540
d
Non-urgent referral for consideration of circumcision
Concept
Chapter
2693
6138
Phimosis and paraphimosis
Topic
143
Urology
19511
Paraphimosis is a medical emergency in which the foreskin is retracted behind the glans and cannot be returned to its normal position, leading to swelling and restricted blood flow that can cause pain and serious complications if not treated promptly.
An 87-year-old male has significant acute penile pain. He lives in a care home and has a long-term catheter in situ, which was changed 4 hours ago. His carers report he was otherwise well before this incident and normally his catheter changes occur without any issues. On examination, he has an enlarged glans with a retracted, oedematous foreskin. The patient reports extreme pain on palpation of the glans and foreskin.

What is the most appropriate management?
a