Evaluating the role of topical steroids as a primary intervention for treatment of phimosis in pediatric age group
DOI:
https://doi.org/10.18203/2349-2902.isj20204425Keywords:
Penis, Phimosis, Steroids, CircumcisionAbstract
Background: Phimosis is the inability to completely retract the prepuce, a common cause of anxiety to parents of young boys. It is usually physiological and gradually improves with age. Phimosis is considered a problem when there is fibrotic foreskin and its adherence to the glans making it impossible to expose the glans.
Methods: Study was conducted on 82 patients that presented to the surgical Outpatient Department (OPD) at Smt. SCL Hospital, NHL Medical College, Ahmedabad for a period of 2 years between September 2011 to September 2013. Case selection was done by detailed history, clinical examination and followed up regularly at 1 week, 2 week and 1 month in necessary individuals. The treatment consisted of applying a topical steroid (betamethasone 0.05% cream) three times a day.
Results: 85% of patients had physiologic phimosis and along with Frenulum Breve the count rose to 91%. Only 9% presented with pathological or acquired phimosis. 51 out of 53 patients who completed the course (96%) achieved success with conservative line of treatment. Only 2 failures were seen (4%). 72.5% of patients responded successfully within 2 weeks of treatment. 27.5% of patients took 1 month of therapy to be successful.
Conclusions: The study has shown that a majority (96%) of boys with phimosis can be successfully treated conservatively. Hence, topical steroids might be used as a first-line therapy for phimosis, as a feasible pre-surgery alternative. Surgical interventions should be reserved for recalcitrant phimosis that do not respond to medical administration.
References
Orsola A, Caffaratti J, Garat JM. Conservative treatment of phimosis in children using topical steroid. Urol. 2000;56:307-10.
Elmore JM, Baker LA, Snodgrass WT. Topical steroid therapy as an alternative to circumcision for phimosis in boys younger than 3 years. J Urol. 2002;168:1746-7.
Chu CC, Chen KC, Diau GY. Topical steroid treatment of phimosis in boys. J Urol. 1999;162:861-3.
Ozkan S, Gurpinar T. A serious circumcision complication: penile shaft amputation and a new reattachment technique with a successful outcome. J Urol. 1997;158:1946-7.
Berdeu D, Sauze L, Ha-Vinh P, Blum-Boisgard C. Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect. BJU Int. 2001;87:239-44.
Gulobovic Z, Milanovic D, Vukadinovic V, Rakie I, Perovic S. The conservative treatment of phimosis in boys. Br J Urol. 1996;78:786-8.
Wright JE. The treatment of childhood phimosis with topical steroid. Aust N Z J Surg. 1994;64:327-8.
Jorgensen ET, Svensson A. The treatment of phimosis in boys, with a potent topical steroid (clobetasol propionate 0.05%) cream. Acta Derm Venereol. 1993;73:55-6.
Atilla MK, Dundaroz R, Odabas O, Ozturk H, Akin R, Gokcay E. A non-surgical approach to the treatment of phimosis: local non-steroidal anti-inflammatory ointment application. J Urol. 1997;158:196-7.
Webster M. Todd, Leonard P. Michael. Topical steroid therapy for phimosis. The Can J Urol. 2002;9(2):1492-95.
Ng WT, Fan N, Wong CK. Treatment of childhood phimosis with a moderately potent topical steroid. ANZ J Surg. 2001;71(9):541-3.
Orsola A, Caffaratti J, Garat JM. Conservative treatment of phimosis in children using topical steroid. Urol. 2000;56:307-10.
Monsour MA, Rabinovitch HH, Dean GE. Medical management of phimosis in children: our experience with topical steroids. J Urol. 1999;162:1162-4.