Kumar and Javle reported a grading system for paraphimosis which correlates with the difficulty to reduce. The authors are from Leighton Hospital in Cheshire, England.
Phimosis is an inability to retract the foreskin over the glans.
Paraphimosis occurs when the retracted foreskin constricts venous and lymphatic drainage from the glans, which can result in a progressive swelling of the glans. This is typically associated with a circumferential fibrous band.
Parameters:
(1) engorgement of glans
(2) skin changes (edema, erosions, etc.)
Engorgement of Glans
Skin Changes
Grade
absent
absent
1
present
absent
2
present
present
3
In extreme paraphimosis the glans can undergo ischemic necrosis with gangrene.
The difficulty in reducing the foreskin increases with increasing grade. A grade 3 paraphimosis cannot be reduced without dividing the fibrotic band.
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