dorsal slit

8/10/2019 Dorsal Slit

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Overview

Dorsal slit of the foreskin is performed to relieve strangulation of the glans by a paraphimosis or tovisualize the urethral meatus in patients with phimosis. [1, 2]Dorsal slit of the foreskin is performed to relievestrangulation of the glans by a paraphimosis or to visualize the urethral meatus in patients with phimosis. [1,2] retrospe!tive study !omparing ele!tive !ir!um!ision versus dorsal slit for ele!tive management ofphimosis found no differen!es between the groups in terms of stenosis, postoperative pain, need for

reoperation, parental appre!iation of postoperative pain, or fun!tional and estheti! satisfa!tion. "leedingwas more fre#uent in the !ir!um!ision group $1.%&' P( .)*+.[*]

ndi!ations

Phimosis

-himosisis the inability of the foreskin to retra!t and epose the glans. [/] Dorsal slit of the foreskin shouldonly be performed on patients who are eperien!ing urinary retention as a result of the phimosis and inwhom a urethral !atheter !annot be blindly inserted.[0] ee image below.

-himoti! foreskin. he distal foreskin is edematous, with !ra!ked fissures. hepatient was unable to retra!t the foreskin.

Paraphimosis

-araphimosisis the inability to repla!e the retra!ted foreskin.[3, %] Dorsal slit of the foreskin should only beperformed on patients whose paraphimosis !ould not be redu!ed with manual te!hni#ues. [4] ee imagebelow.

-araphimosis.

5ontraindi!ations

6o absolute !ontraindi!ations eist to the performan!e of dorsal slit of the foreskin.

Dorsal slit of the foreskin should be performed only after failure of noninvasive te!hni#ues. 7ordetailed des!riptions of manual redu!tion te!hni#ues for paraphimosis, please see 8eds!ape 9eferen!earti!le-araphimosis 9edu!tion -ro!edures.

-ediatri! patients, patients who have bleeding disorders or are taking anti!oagulants, and

patients who are immuno!ompromised or have an infe!ted foreskin are better treated by $or after!onsultation with+ a urologist.[:, 1)]

nesthesia
http://emedicine.medscape.com/article/442617-overviewhttp://emedicine.medscape.com/article/143885-overviewhttp://emedicine.medscape.com/article/143885-overviewhttp://emedicine.medscape.com/article/143885-overviewhttp://emedicine.medscape.com/article/442617-overviewhttp://emedicine.medscape.com/article/143885-overviewhttp://emedicine.medscape.com/article/143885-overview


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Dorsal slit of the foreskin is a painful pro!edure. 5onsider the use of parenteral analgesia with orwithoutpro!edural sedationto redu!e the patient;s dis!omfort.

syringe with a 2%=gauge $ga+ needle, raise a skin wheal of lo!al anestheti! solution withoutepinephrine sub!utaneously in the 12=o;!lo!k position of the dorsal midline of the penis. nsert the needlethrough the skin wheal and advan!e it distally, in?e!ting sub!utaneously as the needle advan!es to thedistal edge of the foreskin $see image below+. his method does not provide analgesia to the ventral

aspe!t of the penis and foreskin.

>o!al anesthesia of the dorsal foreskin.

lternatively, lo!al anesthesia !an be a!hieved by doing a dorsal nerve blo!k with or without a ring blo!k.7or more information, see 6erve "lo!k, Dorsal -enile.

@#uipment

-ovidone=iodine solution $eg, "etadine+

>ido!aine 1=2& without epinephrine

terile gloves

terile drapes

yringe, 0 m>

6eedles, 14 and 2% ga

Aauze s#uares, / / in!hes

traight hemostats or straight Belly !lamps

ris s!issors or 6o. 10 s!alpel

6eedle driver

bsorbable sutures, *=) or /=)

-etroleum gauze

opi!al antiba!terial ointment

-ositioning

he patient should lie supine with his genitalia eposed.

e!hni#ue

Obtain informed !onsent from the patient.

dminister parenteral analgesia with or without a sedative, followed by lo!al anesthesia of the foreskinand penis.

pply povidone=iodine solution to the penis in !ir!ular motions from the glans and proimally to in!ludethe s!rotum and the surrounding skin. 9epeat the iodine appli!ation at least 2 more times and applysterile drapes to !reate a sterile field.

Dorsal slit of the paraphimotic foreskin

fter verifying ade#uate anesthesia of the foreskin, apply 2 hemostats over the foreskin and phimoti! ringat the 11=o;!lo!k and 1=o;!lo!k positions. 8ake sure that the inferior ?aw of the !lamp is below the phimoti!ring and that the superior ?aw is on top of it. "e sure not to !lamp the skin of the penile shaft.
http://emedicine.medscape.com/article/109695-overviewhttp://emedicine.medscape.com/article/109695-overviewhttp://emedicine.medscape.com/article/109695-overviewhttp://emedicine.medscape.com/article/81077-overviewhttp://emedicine.medscape.com/article/81077-overviewhttp://emedicine.medscape.com/article/109695-overviewhttp://emedicine.medscape.com/article/81077-overview


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-ull the 2 hemostats away from ea!h other and have an assistant hold them.


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he in!ised foreskin opens up in a re!tangular fashion.


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n?ury to the urethra or glansC

dorsal slit

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