The Addition of Betamethasone Suppositories to Silver Nitrate Treatment for Hypergranulation Tissue Following Penile...

Hypergranulation tissue (excess granulation tissue) is a common complication following penile inversion vaginoplasty (PIV). It often requires repeated treatment with silver nitrate using a speculum to access the neovagina. This study evaluates whether adding betamethasone suppositories to silver nitrate treatment improves the resolution of hypergranulation tissue after PIV.

A retrospective chart review was conducted on patients who received supplemental betamethasone suppositories in addition to silver nitrate treatment (betamethasone group) between 01/2023 and 12/2024 and matched to a cohort of patients treated with silver nitrate alone (silver nitrate group). Outcomes, number of treatments, and severity of hypergranulation tissue were compared using t tests for continuous variables and Fisher's exact tests for categorical variables.

There were 16 patients in each group, with similar average follow-up times: 8.5 ± 5.5 months (silver nitrate group) and 7.8 ± 4.7 months (betamethasone group) (P = 0.70). At the most recent follow-up, moderate and severe hypergranulation resolved more often in the betamethasone group (86%, 50%) than in the silver nitrate group (60%, 25%). Patients in the betamethasone group with moderate or severe hypergranulation tissue required fewer median treatments for resolution (2 vs 3.5 and 4 vs 5, respectively). After excluding cases that required cauterization under anesthesia, patients in the betamethasone group were significantly more likely to have resolution of their hypergranulation tissue compared to patients in the silver nitrate group (P = 0.035).

Betamethasone is an effective addition to silver nitrate for the treatment of hypergranulation tissue, with our results indicating it can improve resolution and lessen treatment burden in patients' post-PIV.