Acute Paraphimosis : Causes, Symptoms, and Diagnosis , treatment in homeopathy
Surgery

Acute Paraphimosis With Balanitis – A Case Report

Authors:

Dr. Gajraj singh Rathor1, Dr. Yudhishthir Bhardwaj2 , Dr. Bhupendra Arya3

  1. Assistant professor, Department of homoeopathic pharmacy, DR. M.P.K. Homoeopathic Medical College Hospital & Research centre, Siapura, Jaipur, Rajasthan.
  2. PG Scholar, Department of homoeopathic pharmacy, DR. M.P.K. Homoeopathic Medical College Hospital & Research centre, Siapura, Jaipur, Rajasthan.
  3. PG Scholar, Department of practice of medicine, DR. M.P.K. Homoeopathic Medical College Hospital & Research centre, Siapura, Jaipur, Rajasthan.

ABSTRACT:

Paraphimosis occurs when the foreskin of the uncircumcised or partially circumcised male is retracted behind the glans penis, develops venous and lymphatic congestion and cannot be returned to its normal position. This urological emergency impedes blood flow to the glans penis with potential for permanent damage and gangrene. In infants and young children, paraphimosis usually results from self manipulation by the child or inappropriate retraction of the foreskin by the caretaker in misguided attempts at cleaning. In the sexually active adolescent or adult male, intercourse is a potential precipitant. This surgical intervention can be treated through homoeopathic treatment. This case shows the usefulness of homoeopathic medicines in not only giving symptomatic relief to the patient but also restoring the foreskin completely to its normal position.

KEYWORDS: Paraphimosis, Balanitis, Glans penis, Homoeopathy, Inflammation, Penis.

INTRODUCTION:

Paraphimosis is an uncommon medical condition where the foreskin becomes trapped behind the glans penis and cannot be reduced. If this condition persists for several hours or there is any sign of lack of blood flow, paraphimosis should be treated as a medical emergency, as it can result in gangrene or other serious complications.1

The foreskin may be retracted during penile examination, penile cleaning, urethral catheterisation, or cystoscopy; if the foreskin is left retracted for a long period of time, some of the foreskin tissue may become edematous, which makes subsequent reduction of the foreskin difficult. Phimosis of both pathological and normal childhood physiological forms is a risk factor for paraphimosis; physiological phimosis resolves naturally as a child matures, but pathological phimosis needs to be treated through long term stretching or elective surgical techniques such as preputioplasty to loosen the preputial orifice and circumcision to amputate the foreskin tissue partially or completely.2

CASE REPORT:

A male boy aged 15 years, a high school student, came to the OPD of Dr. GIRENDRA PAL homoeopathic Hospital, Saipura, Jaipur, Rajasthan on 18-09-2019 with complaints of swelling of genitalia, particularly prepuce and glans penis, and fever for the past 7 days. The fever was higher in the forenoon. The boy was subjected to the investigations of erythrocyte sedimentation rate (ESR), total leucocyte count (TLC), differential leucocyte count (DLC), haemoglobin (Hb) %, and urine analysis, which were found to be within normal limits. Earlier, the boy was treated with a course of antibiotics and anti-inflammatory preparations, without satisfactory improvement. On local examination, oedematous swelling of glans penis and prepuce, and tenderness were present [Figure 1]. Past medical history was not significant. All the presenting symptoms of paraphimosis with balanitis were repertorised with complete repertory[9] in Hompath Software.[10] On repertorisation, a series of homoeopathic drugs, Arsenicum album, Rhus toxicodendron, Apis mellifica, Cinnabaris and Mercurius solubilis, were found to have covered the maximum presenting symptoms and signs of paraphimosis with balanitis. The outcome of repertorisation with weightage of different drugs is given in Table 1. The medicines Apis mellifica prescribed on the basis of the presenting symptoms and signs of the disease picture, subsequent presentation of the disease picture. The boy successfully responded to the treatment and the condition was completely resolved in a couple of weeks [Figure 2]. During the course of treatment, the medicines were also prescribed on basis of reporarisation. Details of the follow-up, response and prescription of medicines are given in Table 2.

Figure 1: before treatment (dt. 18-09-2019)

Figure 2: after treatment (dt. 03-10-2019)

Table 1: Repertorial outcome:

Table 2: First and follow-up visits:

Date of visit and follow-up visits Symptoms Medicine and doses
18-9-2019 Oedematous, inflammatory swelling of prepuce and glans penis Stinging and burning pain with fever Apis mellifica  30 BD/day ×3 days
21‑09‑2019   Fever relieved Oedematous, inflammatory swelling of prepuce and glans penis status relieved Rubrum 30 tds ×3 days
24-09-2019 Oedematous, inflammatory swelling of prepuce and glans penis status relieved patient feel better   Rubrum 30 tds ×3 days
27-09-2019 Patient feel better and improved Rubrum 30 tds ×3 days
30-09-2019 No symptoms present Rubrum 30 tds ×3 days
03-10-2019 No symptoms present Rubrum 30 tds ×3 days

DISCUSSION AND CONCLUSION:

Paraphimosis is usually considered as a surgical condition in its pathological form and is usually treated by the surgical method preputioplasty to loosen the preputial orifice or by circumcision to amputate the foreskin tissue partially or completely. In certain occasions, the condition is treated by manual manipulation of the swollen foreskin tissue, and if this fails, the tight Oedematous band of tissue is relieved surgically with a dorsal slit. The patient visited the OPD of Dr. GIRENDRA PAL HOMOEOPATHIC Hospital, Village Saipura, Jaipur, Rajasthan for the acute condition of paraphimosis and balanitis [Figure 1]. He had earlier taken a course of antibiotics and anti‑inflammatory drugs for treating this condition, for which he did not respond favourably. The case was repertorised with all the disease symptoms of paraphimosis with balanitis. During the first 6 days of treatment, Apis mellifica 30CH potency was prescribed based on the coverage and weightage after repertorisation. Though the fever was reduced with Apis mellifica 30CH potency, there was improvement in paraphimosis. Later on, based on the response to this drug, the next rubrum 30 potency were prescribed as tds, respectively, for 3 days. The paraphimosis was significantly improved. Therefore, the same medicines (rubrum) were continued in 30potency for another 3 days and the condition was resolved completely within 15 days [Figure 2]. Usually, the medicines covering the symptoms with equal weightage, when prescribed simultaneously are found to relieve the sufferings effectively in acute conditions like inflammatory arthritis, acute coryza, dyspepsia, acute headaches of different origin, etc. It is very clear from the case that certain acute medical/surgical conditions like paraphimosis with balanitis can be successfully managed with homoeopathic medicines. In acute clinical conditions, presenting clinical picture of the disease suggesting indications of more than one drug can be frequently and alternately prescribed for achieving good results.

REFERENCES

  1. Donohoe JM, Burnette JO, Brown JA. Paraphimosis. eMedicine. Available from: http://emedicine.medscape.com/article/442883 [Last accessed on 2011 Mar 19].
  2. Ghory HZ, Sharma R. Phimosis and Paraphimosis. eMedicine. Available from: http://emedicine.medscape.com/article/777539 [Last accessed on 2011 Mar 19].
BHUPENDRA ARYA
Author: BHUPENDRA ARYA

Dr.Bhupendra arya,MD Scholar, Department of practice of medicine , Dr. M.P.K.Homoeopathic Medical College , a constituent college of Homoeopathy University , jaipur

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