What criteria should I use to determine whether to refer a patient with paraphimosis for surgical intervention?

The provided UK guideline excerpts do not explicitly detail specific criteria for surgical intervention solely for paraphimosis ¹,²,³,⁴. However, they do outline criteria for surgical referral related to phimosis, a condition that can predispose to paraphimosis, and its complications.

Surgical circumcision may be considered for phimosis if symptoms do not respond to potent topical corticosteroids under specialist monitoring ¹. Additionally, if complications such as phimosis, meatal stenosis, or urethral stricture arise, surgical circumcision, meatotomy, or urethroplasty may be required ¹.

For paediatric patients, referral to a paediatric urologist or surgeon for consideration of circumcision is recommended if there is suspected lichen sclerosus and/or persistent phimosis ¹. This referral is also advised if phimosis due to lichen sclerosus has not responded to topical corticosteroid treatment ¹. Furthermore, severe lichen sclerosus changes and severe, recurrent attacks of balanitis are considered medical indications for circumcision in paediatric patients ¹. Persistent balanitis that does not respond to optimal primary care treatment and lacks evidence of an underlying infective cause after sub-preputial swabs may also benefit from surgical assessment, as circumcision can be curative ¹.