1107 - When Sensation Fails: A Case of Paraphimosis in Acute Spinal Cord Injury

Case Diagnosis: Complete SCI with Paraphimosis

Case Description: A 35-year-old male with intellectual disability and recent C5 AIS A spinal cord injury (SCI) was admitted to rehabilitation after sustaining bilateral C5 facet fractures. He underwent posterior cervical fusion complicated by neurogenic bladder, requiring placement of a foley catheter. On day 4 of rehabilitation, staff noted penile swelling and erythema with retracted foreskin. Vital signs and laboratory assessment did not suggest acute infection. Scrotal ultrasound did not reveal evidence of testicular torsion, epididymitis, orchitis, or hydrocele. The patient was subsequently sent to the emergency department where he was diagnosed with paraphimosis. Penile Edema was initially reduced with granulated sugar, followed by successful manual reduction. Compression with Ace wrap and Coban was applied, and the foreskin was repositioned over the glans without trauma.

Discussions: Paraphimosis is a urologic emergency that can lead to penile ischemia or autonomic dysreflexia if not promptly managed. It is diagnosed clinically and should be distinguished from priapism, testicular torsion and other conditions associated with genitourinary infections. Patients with high cervical SCI are at increased risk due to impaired sensation, neurogenic bladder, chronic catheter use, and communication barriers. This case was further complicated by intellectual disability, limiting symptom reporting. Routine genital exams and strict catheter protocols are essential in this population given that paraphimosis has a higher incidence rate among those with indwelling foley catheters. If manual reduction with granulated sugar fails, osmotic agents such as 50% dextrose or hyaluronidase injections are recommended to avoid emergency urological surgery.

Conclusions: In patients with SCI, paraphimosis may go unnoticed until complications emerge. Regular catheter inspection and structured bladder protocols are critical. Prompt foreskin reduction with granulated sugar after cleaning or catheterization can prevent sequelae such as autonomic dysreflexia—a potentially life-threatening condition. This case underscores the importance of anticipatory care and caregiver education in acute rehabilitation settings.