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Topical steroid therapy as an alternative to circumcision for phimosis in boys younger than 3 years
James M Elmore1, Linda A Baker, Warren T Snodgrass
1Department of Urology, Children's Medical Center and The University of Texas Southwestern Medical Center, Dallas, TX 75235, USA.
Insights
Topical steroid cream effectively treated phimosis in infants and young children, offering a non-surgical alternative to circumcision. This treatment resolved foreskin retraction issues in most boys, with no reported side effects.
Area of Science:
- Pediatric Urology
- Dermatology
- Pharmacology
Background:
- Phimosis, the inability to retract the foreskin, is common in infants and young children.
- Topical steroids are an established treatment for older boys with secondary phimosis.
- Circumcision is a common but invasive treatment for phimosis.
Purpose of the Study:
- To evaluate the effectiveness of topical steroids as a non-surgical treatment for phimosis in infants and young children.
- To determine if topical steroid therapy is a viable alternative to circumcision in this age group.
Main Methods:
- A study included 27 boys aged 1-31 months with phimosis.
- Patients applied 0.05% betamethasone cream twice daily for one month.
- Indications for potential circumcision included genitourinary anomalies, urinary tract infections, or balanoposthitis.
Main Results:
- 74% of boys achieved fully retractable foreskins after one month of betamethasone treatment.
- An additional 18% showed partial improvement, with full retraction occurring in the second month.
- No adverse side effects were observed during the treatment period.
Conclusions:
- Topical steroid therapy, specifically betamethasone, is effective in resolving phimosis in boys under three years old.
- This treatment offers a safe and effective alternative to circumcision for phimosis across all age groups and indications.
- Topical steroids represent a significant advancement in non-invasive phimosis management for pediatric patients.
Unlabelled:
PURPOSE Topical steroids are an effective alternative to circumcision for the treatment of phimosis. However, their use has been reported primarily in older boys thought to have "pathological" or secondary phimosis. We report the effectiveness of topical steroids as an alternative to circumcision in infants and young children.
Material And Methods:
We evaluated 27 boys with phimosis for possible circumcision because of genitourinary anomalies (4), a history of urinary tract infection (11) or both (7), or balanoposthitis (5). Patient age ranged from 1 to 31 months (mean 11.3). In no case could the prepuce be retracted to visualize the meatus. Patients were treated with 0.05% betamethasone cream applied to the distal aspect of the prepuce twice daily for 1 month.
Results:
Of the boys 20 (74%) had fully retractable foreskins after 1 month of treatment with betamethasone and 5 (18%) had a partial response at 1 month, with the prepuce becoming fully retractable during month 2 of therapy. No adverse side effects were noted. Of the 2 patients in whom treatment failed 1 subsequently underwent circumcision while the parents of the other refused further therapy.
Conclusions:
Topical steroids appear to resolve phimosis effectively in boys younger than 3 years. Given proven efficacy in children older than 3 years, topical steroid therapy represents a potential alternative to circumcision regardless of the age of the patient, type of phimosis or relative indication for treatment.
