Topical corticosteroids for treating phimosis in boys

Area of Science:

• Pediatric Urology
• Dermatology
• Evidence-Based Medicine

Background:

• Phimosis historically treated with surgery (circumcision, prepuceplasty).
• Emerging evidence supports non-invasive topical corticosteroid treatment (4-8 weeks).
• Systematic review on topical corticosteroid efficacy and safety in boys with phimosis is lacking.

Purpose of the Study:

• Compare topical corticosteroid effectiveness versus placebo/no treatment for phimosis resolution in boys.
• Determine rates of partial resolution, re-stenosis, and adverse events with topical corticosteroids.

Main Methods:

• Systematic review of randomized controlled trials (RCTs).
• Searched Cochrane Renal Group's Specialized Register (up to June 2014).
• Included RCTs comparing topical corticosteroids with placebo/no treatment for boys with phimosis.

Main Results:

• 12 RCTs (1395 boys) included; varied corticosteroids and durations.
• Corticosteroids significantly increased complete/partial phimosis resolution vs. placebo (RR 2.45).
• Adverse events reporting was inadequate; risk of bias assessment was challenging due to poor reporting.

Conclusions:

• Topical corticosteroids are an effective, safe, and less invasive first-line treatment for phimosis in boys.
• Suboptimal reporting in studies limits precise effect size determination.
• Recommend topical corticosteroids as a pre-surgical option for pediatric phimosis.