The use of hyaluronidase facilitates reduction of paraphimosis. It acts by dispersing extracellular edema, permitting easy reduction of the foreskin. Its use is applicable both in the hospital and out- patient setting.
Hyaluronidase is widely available and keeps well if refrigerated.
It is effective for children and adults. Recommendations for its reduction involve reassurance, followed by wrapping the penis with elastic, squeezing the prepuce or exerting considerable pressure to force the foreskin over the glans. Subdermal introduction of hyaluronidase obviates the need for forceful reduction of the prepuce or a dorsal slit procedure. It is the natural protein responsible for hydrolysis of the extracellular mucopolysaccharide, hyaluronic acid. The commercially available enzyme is prepared from mammalian testes and is available as a lyophilized powder or as as stabilized clear solution or injection.