Local steroid therapy as the first-line treatment for boys with symptomatic phimosis - a long-term prospective study
Srinath Reddy1, Viral Jain, Manish Dubey
1Department of Pediatrics, MGM University of Health Sciences, Navi Mumbai, India.
Insights
Local steroid therapy (LST) effectively treats phimosis in most children, with rapid improvement often seen within two weeks. While generally safe and successful, some cases may recur, necessitating surgery.
Area of Science:
- Pediatric Urology
- Dermatology
Background:
- Phimosis is a prevalent pediatric urological condition often treated with circumcision.
- Local steroid therapy (LST) is explored as a primary treatment option.
Purpose of the Study:
- To prospectively evaluate the efficacy and safety of LST as a first-line treatment for pediatric phimosis.
Main Methods:
- 260 boys (up to 15 years) with phimosis received 0.05% betamethasone dipropionate cream applied to the prepuce twice daily.
- Objective grading of phimosis and follow-up at 1, 2, and 4 weeks, and 6 months were conducted.
Main Results:
- 91% of boys achieved successful phimosis alleviation within 4 weeks; 72% responded in week 1, and 16% in week 2.
- Long-term follow-up (mean 25.4 months) showed a 77% success rate, with 17.8% experiencing recurrence.
- 23% of boys ultimately required surgical intervention.
Conclusions:
- LST is a safe and effective first-line therapy for the majority of children with symptomatic phimosis.
- Therapeutic response is typically observed within the first two weeks of treatment.
- Extended LST beyond two weeks showed minimal additional benefit.
Aim:
Phimosis is a common paediatric urological disorder and often necessitates circumcision. We prospectively evaluated local steroid therapy (LST) as the first choice therapy for such children.
Methods:
Two hundred and sixty symptomatic boys up to 15 years of age (mean 34 months) with phimosis were started on betamethasone dipropionate (0.05%) application on gently stretched prepuce twice a day. Follow-up visits were arranged at the end of weeks 1, 2 and 4 and 6 months. Grade of phimosis was objectively graded.
Results:
Ninety one percent of the boys showed a successful outcome at the end of 4 weeks; 72% responded in first week, further 16% responded in week 2, and only 2.6% achieved alleviation of phimosis on further application of LST beyond 2 weeks. Fourty two (17.8%) boys had a recurrence of phimosis on a long-term follow-up (mean - 25.4 months, range 6-48 months); thus, the long-term success rate was 77%, while 60 (23%) boys underwent surgery.
Conclusion:
Local steroid therapy is safe and successful in alleviating symptomatic tight foreskin in a large majority of children. The response can be seen as early as 1 week; most of the children respond by week 2 and continuing therapy further may not be very effective.