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Conservative treatment of phimosis in children using a topical steroid
A Orsola1, J Caffaratti, J M Garat
1Department of Pediatric Urology, Fundacio Puigvert, Barcelona, Spain.
Insights
Topical steroid cream effectively treats childhood phimosis in 90% of cases, avoiding surgery. Consistent daily foreskin care is crucial for successful outcomes in both primary and secondary phimosis.
Area of Science:
- Pediatric Urology
- Dermatology
Background:
- Phimosis is a common condition in young boys.
- Surgical intervention has historically been the primary treatment for phimosis.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of topical steroid treatment for childhood phimosis.
- To assess the effectiveness of topical steroids in both primary and secondary phimosis cases.
Main Methods:
- A prospective study involving 137 boys treated with 0.05% betamethasone cream applied twice daily for one month.
- Prepuce retraction was performed after the fifth day of treatment.
- Outcomes were assessed at the end of treatment and six months later.
Main Results:
- 90% of patients achieved an easily retractable prepuce without phimotic rings six months post-treatment.
- Treatment success rates were similar for primary and secondary phimosis.
- The treatment was well-tolerated with no reported local or systemic side effects.
Conclusions:
- Topical steroid therapy offers a safe, simple, and cost-effective alternative to surgery for childhood phimosis.
- Consistent adherence to daily foreskin care is essential for sustained treatment success.
- Topical steroids are effective for both primary and secondary phimosis, with potential mechanisms of action warranting further investigation.
Objectives:
From 1997 through 1998, we conducted a prospective study to evaluate the long-term outcome of using topical steroids in the treatment of childhood phimosis.
Methods:
Both the parents and their children were instructed to apply 0.05% betamethasone cream topically twice a day for 1 month and to retract the prepuce after the fifth day of treatment. Results were evaluated at the end of the treatment and 6 months later.
Results:
One hundred thirty-seven boys were evaluated. The median age was 5.4 years. At initial presentation, 61 boys had a phimotic but retractable prepuce, 37 had a nonretractable phimotic ring, and 39 had a pinpoint opening. Patients with a history of previous forcible foreskin retractions were considered to have secondary phimosis. By 6 months following treatment, 90% (124 children) had an easily retractable prepuce without a phimotic ring. No differences were seen in the response rate between those with primary and secondary phimosis. In all cases, the treatment was well tolerated without local or systemic side effects. All the patients with persistent or recurrent phimosis were found to be noncompliant with the suggested daily foreskin care.
Conclusions:
Topical steroid for the treatment of phimosis is a safe, simple, and inexpensive procedure that avoids surgery and its associated risks. It is effective both in primary and in secondary phimosis. We emphasize the importance of proper and regular foreskin care and hypothesize on the mechanism of action of the steroids.