Topical steroids are effective even in severe phimosis: Evidence from a multicenter cohort

Phimosis is commonly encountered in pediatric surgical practice. Despite evidence supporting topical corticosteroids for phimosis, many clinicians believe they are ineffective in certain subgroups such as severe phimosis or older children, leading to early circumcision. This study aimed to evaluate the effectiveness of topical corticosteroids across different severities and patient characteristics. We conducted a prospective multicenter cohort study across 12 Chilean hospitals between June 2023 and August 2024. Boys under 18 years old with phimosis grades 2 to 5 (Kikiros classification) were treated with 0.05% topical betamethasone twice daily for 8 weeks. Patients were followed up between 8 and 16 weeks. Resolution was defined as improvement to Kikiros grades 0-1. Variables related to treatment outcomes were assessed using univariate and multivariate logistic regression analyses. Out of 386 eligible patients, 235 completed follow-up and were included in the final analysis. Overall treatment success was 68%, with no significant differences across phimosis severity or age groups. The only factor significantly associated with treatment failure was altered preputial skin appearance (success rate: 72% with healthy skin vs. 29% with altered skin; p = 0.007). Other variables, including treatment adherence, age, symptoms, or prior balanitis, were not predictive of treatment failure. Topical corticosteroids are effective for treating phimosis in children, regardless of severity, age or other pre-treatment variables studied. Altered preputial skin appearance may predict lower response rates. These findings support broader implementation of conservative management and may help reduce unnecessary surgical interventions. LEVEL OF EVIDENCE: Level 2b, according to the Oxford Centre for Evidence-Based Medicine (2009).