When paraphimosis is consecutive to ulceration and in no danger of causing gangrene, hot compresses or lead-water should be applied and at the same time the original lesion should be treated. These cases usually reduce spontaneously. If not, they should be treated as above described. Should the brawny cedema of the reduced tissues persist for several weeks or months, circumcision is to be recommended.
Injuries of the Severe contusions of the penis occasion so intense an ecchymosis and cedema as to simulate rapid gangrene. Small cir cumscribed tumors form, most promi nent during erection, and result from the rupture of vessels in the cavernous bodies, forming hzematomata. When the ure thra is involved, blood will escape from the meatus, and inflammatory phenom ena quickly develop.
Treatment.—Contusion may be treated by rest, elevation, and the application of hot antiseptic compresses. If the symp toms are progressive, an incision should be made under strict antiseptic precau tions and the bleeding vessels ligated. Emphysema is a serious symptom and necessitates free incisions, as does the first sign of suppuration; thorough drainage in this instance is essential.
Extensive swelling and discoloration should not occasion alarm unless there has been rupture of the urethra or the cavernous or spongy bodies.
INcisEn WOUNDS. — Incised wounds, when slight, heal quickly when closed early. If, however, they are deep and the erectile tissue is involved, free haemor rhage results, and the possible loss of the power of erection in the part anterior to the wound. When the penis is com pletely divided may be so serious as to cause death unless quickly controlled.
Treatment.—All is to be controlled by ligature, the venous oozing is checked by the simple apposition of the cut surfaces. If it cannot be so con trolled, a hard-rubber catheter may be introduced into the urethra and a tight roller-bandage applied. Such remedies as have a tendency to prevent erections should be administered internally. No matter how extensive the wound, an ef fort should always be made to suture together a divided penis.
When the urethra is divided, it should be sutured, and a catheter introduced through the urethra into the bladder to prevent the formation of a urinary fis tula; it should be removed at the end of the seventh day.