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Ice, pins, or sugar to reduce paraphimosis
  1. Kevin Mackway-Jones, Consultant,
  2. Stewart Teece, Clinical Research Fellow
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK;


    A short cut review was carried out to establish which of the ice glove technique, the multiple puncture technique, or the application of sugar was the best approach for paraphimosis reduction. Thirty three papers were found using the reported search, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Kevin Mackway-Jones, ConsultantChecked by Stewart Teece, Clinical Research Fellow

    Clinical scenario

    You are asked to see a 19 year old man who has presented to the emergency department with paraphymosis. He states that he fell asleep after sex the night before and woke up with swelling. Simple traction has failed to cure the problem (but has brought tears to his eyes). A surgeon, a specialist registrar in emergency medicine, and a urologist are already in attendance. The first says that multiple punctures should be made with a needle, the second that an iced glove should be used, and the third that sugar should be applied. You wonder whether any of the suggested methods are evidence based.

    Three part question

    In [an adult male with irreducible paraphimosis] is [ice better than multiple puncturing or sugar] at [reducing swelling and allowing reduction]?

    Search strategy

    Medline 1966-10/03 using the OVID interface. [ OR OR exp paraphimosis OR ( AND] AND [reduc$.mp OR exp ice OR ice$.mp OR puncture$.mp OR exp punctures OR].

    Search outcome

    Altogether 33 papers found, of which three were relevant (table 4).

    Table 4


    There are no comparative or randomised trials in this area. Current treatment is based wholly on custom, practice, and word of mouth. Further research is warranted.


    All three methods have been shown to work, but there is no evidence to show which is best. Local guidelines should be followed.

    Report by Kevin Mackway-Jones, ConsultantChecked by Stewart Teece, Clinical Research Fellow


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