The provided UK guideline excerpts do not explicitly detail specific criteria for surgical intervention solely for paraphimosis NICE CKS,NICE CKS,NICE CG97,NICE NG12. 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 NICE CKS. Additionally, if complications such as phimosis, meatal stenosis, or urethral stricture arise, surgical circumcision, meatotomy, or urethroplasty may be required NICE CKS.
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 NICE CKS. This referral is also advised if phimosis due to lichen sclerosus has not responded to topical corticosteroid treatment NICE CKS. Furthermore, severe lichen sclerosus changes and severe, recurrent attacks of balanitis are considered medical indications for circumcision in paediatric patients NICE CKS. 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 NICE CKS.