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 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 7  |  Issue : 3  |  Page : 133-136

Evidence-based homoeopathy: A case of acute paraphimosis with balanitis


Regional Research Institute for Homoeopathy, Gudivada, Andhra Pradesh, India

Date of Submission13-Mar-2013
Date of Acceptance04-Sep-2013
Date of Web Publication30-Sep-2013

Correspondence Address:
Chinta Raveendar
Asst. Director (H), Scientist 4, Officer in Charge, Regional Research Institute for Homoeopathy, Dr. GGH Medical College Campus, Eluru Road, Gudivada 521 301, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7168.119116

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  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. Iatrogenic paraphimosis follows cystoscopy or bladder catheterisation if the foreskin is not pulled back over the glans penis by the medical provider. This surgical intervention can be avoided through homoeopathic treatment. A case of paraphimosis with balanitis of an adolescent treated with homoeopathy is reported here. This case shows the usefulness of homoeopathic medicines, Apis mellifica, Rhus toxicodendron, Cinnabaris and Mercurius solubilis, in not only giving symptomatic relief to the patient but also restoring the foreskin completely to its normal position.

Keywords: Balanitis, Glans penis, Homoeopathy, Inflammation, Paraphimosis, Penis, Prepuce


How to cite this article:
Raveendar C, Banoth K. Evidence-based homoeopathy: A case of acute paraphimosis with balanitis. Indian J Res Homoeopathy 2013;7:133-6

How to cite this URL:
Raveendar C, Banoth K. Evidence-based homoeopathy: A case of acute paraphimosis with balanitis. Indian J Res Homoeopathy [serial online] 2013 [cited 2018 Dec 10];7:133-6. Available from: http://www.ijrh.org/text.asp?2013/7/3/133/119116


  Introduction Top


Paraphimosis is an uncommon clinical condition where the foreskin becomes trapped behind the glans penis and cannot be reduced (i.e. pulled back to its normal flaccid position covering the glans penis). [1] 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],[2],[3] Paraphimosis is usually caused by medical professionals or parents handling the foreskin improperly. [1],[3] 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 oedematous, 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]

Paraphimosis can often be treated by manual manipulation of the swollen foreskin tissue. This involves compressing the glans and moving the foreskin back to its normal position with the aid of a lubricant, cold compression and local anaesthesia, as necessary. If this fails, the tight oedematous band of tissue can be relieved surgically with a dorsal slit [1],[3] or circumcision. [4],[5],[6],[7],[8]


  Case Report Top


A male boy aged 15 years, a high school student, came to the OPD of Regional Research Institute for Homoeopathy [RRI (H)], Gudivada on 18-03-2011 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) %, retroviral screening 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.
Figure 1: Paraphimosis with balanitis - before treatment (dt. 18-03-2011)

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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, Rhus toxicodendron, Cinnabaris and Mercurius solubilis were prescribed on the basis of the presenting symptoms and signs of the disease picture, and the prescribed medicines were changed from time to time depending upon the response to the earlier medicines and 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].
Figure 2: Complete relief of paraphimosis with balanitis - after treatment (dt. 05-04-2011)

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Table 1: Repertorial outcome with weightage of medicines


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During the course of treatment, the medicines were also prescribed on alternation basis, that is, Cinnabaris 30 and Mercurius solubilis 30 for 4 days. These types of alternating prescriptions were also given by certain homoeopathic stalwarts [11] in acute conditions. Details of the follow-up, response and prescription of medicines are given in [Table 2].
Table 2: First and follow-up visits


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  Discussion and Conclusion Top


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 RRI (H), Gudivada 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 and Rhus toxicodendron in 30 CH potency were prescribed based on the coverage and weightage after repertorisation. Though the fever was reduced with Apis mellifica 30CH potency, there was no improvement in paraphimosis, and Rhus toxicodendron was prescribed. No inimical relationship was observed between Apis mellifica and Rhus toxicodendron. Later on, based on the response to these drugs, the next equal weightage medicines, Cinnabaris and Mercurius solubilis, in 30 potency were prescribed as morning 1 dose and evening 1 dose, respectively, for 4 days. Within 7 days of prescribing Cinnabaris and Mercurius solubilis in 30 potency, the paraphimosis was significantly improved, but the condition was still persisting.

Therefore, the same medicines were continued in 200 potency for another 4 days and the condition was resolved completely within 4 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 Top

1.Donohoe JM, Burnette JO, Brown JA. Paraphimosis. eMedicine. Available from: http://emedicine.medscape.com/article/442883 [Last accessed on 2011 Mar 19].  Back to cited text no. 1
    
2.Ghory HZ, Sharma R. Phimosis and Paraphimosis. eMedicine. Available from: http://emedicine.medscape.com/article/777539 [Last accessed on 2011 Mar 19].  Back to cited text no. 2
    
3.Choe JM. Paraphimosis-Current Treatment Options. Am Fam Phys 2000;62:2623-6, 2628.  Back to cited text no. 3
    
4.Santucci RA, Terlecki RP. Phimosis, adult circumcision, and buried penis. eMedicine. Available from: http://emedicine.medscape.com/article/442617 [Last accessed on 2011 Mar 19].  Back to cited text no. 4
    
5.Reynard JM, Barua JM. Reduction of paraphimosis the simple way-the Dundee technique. BJU Int 1999;83:859-60.   Back to cited text no. 5
[PUBMED]    
6.Surgical care at the district hospital. Geneva: World Health Organization. pp. 9-10. ISBN 9241545755. Available from: http://whqlibdoc.who.int/publications/2003/9241545755.pdf [Last accessed on 2011 Mar 19].  Back to cited text no. 6
    
7.Stead LG, Stead SM, Kaufman MS. First Aid for the Emergency Medicine Clerkship. pp. 231. ISBN 007144873X. Available from: http://books.google.co.in/books?id=ugepIbeFAVYC and dq=isbn%3A007144873X and q=paraphimosis#search_anchor [Last accessed on 2011 Mar 19].   Back to cited text no. 7
    
8.Zderic S, Platcher N, Kirk J. Pediatric Urology for the Primary Care Provider. pp. 80. ISBN 1556427859. Available from: http://www.openisbn.com/preview/1556427859/[Last accessed on 2011 Mar 19].  Back to cited text no. 8
    
9.Van Zandvoort R. Complete Repertory. Accessed from Homoeopathic classic 8.0 version soft ware. Mind Technologies, Mumbai, India; 2002.  Back to cited text no. 9
    
10.Homoeopathic classic 8.0 version soft ware. Mind Technologies, Mumbai, India.  Back to cited text no. 10
    
11.Mathur KN. Prescribing on the basis of alternations and combinations of remedies. In: Mathur KN, editor. Principles of prescribing. New Delhi: B. Jain Publishers (P) Ltd; 1995. p. 454-76.  Back to cited text no. 11
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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