Nonsurgical separation and topical Clobetasol therapy for phimosis

Bhavinder K. Arora; Rachit Arora; Akshit Arora

doi:10.18203/2349-2902.isj20164471

Authors

Bhavinder K. Arora Department of Surgery, Pt BD Sharma PGIMS, Rohtak, Haryana, India
Rachit Arora MBBS student 4th year, VMMC and Safdarjung Hospital, New Delhi, India
Akshit Arora MBBS student 2nd year, VMMC and Safdarjung Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2349-2902.isj20164471

Keywords:

Adhesiolysis, Clobetasol therapy, Non-surgical separation, Non-retractile foreskin, Phimosis, Topical steroid

Abstract

Background:Phimosis is non-retractile foreskin or prepuce over the glans. This is due flimsy adhesions between glans and prepuce. The two types of phimosis, physiological and pathological must be differentiated. The phimosis can be treated by conservative methods by application of topical steroid cream. The objective of this study was to evaluate the efficacy of nonsurgical separation and topical clobetasol propionate 0.05% cream therapy in treatment of phimosis.

Methods: This study was done on 62 patients presenting with symptoms of phimosis were included in the study. The clinical examination prepuce and penis was done. The patients were classified according to Kirkiros classification. In this classification of phimosis, 5 grades have been ascribed according to the retractibility of prepuce.

Results:Out of total 62 patients, the complete response was obtained in 55 (80.71%), partial response in 5 (8.06%) and no response in 2 (3.23%) patients. In patients with partial response the topical clobetasol therapy, the treatment was repeated for another 4 weeks. The phimotic ring disappeared in all the patients after 4 or 8 weeks of topical clobetasol propionate 0.05% cream application. The surgical therapy either circumcision or preputioplasty should be done only in selected cases.

Conclusions:This study concludes that nonsurgical separation and topical clobetasol cream therapy is quite effective for treatment of phimosis.

Metrics

Metrics Loading ...

References

Malone P, Steinbrecher H. Medical aspects of male circumcision. BMJ. 2007;335:1206-9.

Shahid SK. Phimosis in children. ISRN Urology. 2012;Article ID 707329:6.

McGregor TB, Pike JG, Leonard MP. Phimosis - a diagnostic dilemma. Can J Urol. 2005;12:2598-602.

Kumar P, Deb M, Das K. Preputial adhesions - a misunderstood entity. Indian J Pediatrics. 2009;76(8):829-32.

Steadman B, Ellisworth P. To circ or not to circ: indications, risk and alternatives to circumcision in the paediatric population with phimosis. Urologic Nursing. 2006;26(3):181-94.

Barber NJ, Chapell B, Carter PG, Britton MD. Is preputioplasty effective and acceptable. J R Soc Med. 2003;96:452-3.

MacKinlay GA. Save the prepuce: painless separation of preputial adhesions in the outpatient clinic. Br Med J. 1988;297(6648):590-1.

Kikiros CS, Beasley SW, Woodward AA. The response of phimosis to local steroid application. Pediatr Surg Int. 1993;8:329-32.

Sorrells ML, Snyder L, Reiss MD. Fine touch thresholds in the adult penis. Br J Urol International. 2007;99(4):864-9.

Cooper GC, Thomson GJL, Raine PAM. Therapeutic retraction of foreskin in childhood. Br Med J. 1983;286(6360):186-7.

Camile CJ, Kuo RL, Wiener JS. Caring for the uncircumcised penis: what parents and you need to know. Contemporary Pediatrics. 2002;11:61.

Lim A, Saw Y, Wake PN, Croton RS. Use of a eutectic mixture of local anaesthetics in release of preputial adhesions: is it a worthwhile alternative. British J Urology. 1994;73(4):428-30.

Monsour MA, Rabinovitch HH, Dean GE. Medical management of phimosis in children: our experience with topical steroids. J Urol. 1999;62(3):1162-4.

Kragballe K. Topical cortisteroids: mechanism of action. Acta Dermato Venereologica. 1989;69(151suppl):7-10.

Palmer LS, Palmer JS. The efficacy of topical betamethasone for treating phimosis: a comparison of two treatment regimens. Urology. 2008;72(1):68-71.

Dewan PA, Tieu HC, Chieng BS. Phimosis: is circumcision necessary. J Paediatr Child Health. 1996;32(4):285-9.

Elmore JM, Baker LA, Snodgras WT, Dewan P. Topical steroid therapy as an alternative to circumcision for phimosis in boys younger than 3 years. J Urol. 2002;168(4suppl):1746-7.

Ashfield JE, Nickel KR, Siemens DR, MacNeily AE, Nickel JC. Treatment of phimosis with topical steroids in 194 children. J Urol. 2003;169(3):1106-8.

Berden 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. British J Urol Inter. 2001;87(3):239-44.

Chu CC, Chen KEC, Diau GY. Topical steroid treatment for treatment of phimosis in boys. J Urol. 1999;162(3):861-3.

Jorgensen ET, Svensson A. The treatment of phimosis in boys, with a potent topical steroid clobetasol propionate 0.05% cream. Acta Demato Venerologica. 1993;73(1):55-6.

Ghysel C, Vander K, Bogaert GA. Long term efficiency of skin stretching and a topical corticoid cream application for unretractable foreskin and phimosis in prepubertal boys. Urol Inter. 2009;82(1):81-8.

Zampieri N, Corroppolo FS, Camoglio L, Ottolenghi A. Phimosis: stretching methods with or without application of topical steroids. J Pediatr. 2005;147(5):705-6.

Iken A, Ben Mouelli S, Fontaine E, Quenneville V, Thomas L, Beurton D. Treatment of phimosis with locally applied 0.05% clobetasol propionate: prospective study with 108 children. Proq Urol. 2002;12(6):1268-71.

Lee CH, Lee SD. Effect of topical steroids 0.05% clobetasol propionate treatment in children with severe phimosis. Korean J Urol. 2013;54:624-30.