Introduction: Circumcision has been the traditional treatment for phimosis. We present our results with topical steroid therapy for treatment of phimosis. Materials and methods: Retrospective review of 69 boys between the age of 3 and 13 years average 7. Boys without a distal preputial ring were excluded. Six weeks after treatment initiation patients were reassessed. Results were classified as follows: Full retraction FR -entire glans and coronal margin seen, Moderate retraction MR -proximal glans seen, residual preputial adhesions, Partial retraction PR -distal glans and meatus seen, and Failure F -no change.
Statistical analysis was performed with Splus software using the prop. Results: Follow-up ranged from months, and 8 patients were lost to follow-up. Studies that correlate foreskin anatomy with topical treatment using corticosteroids in patients with phimosis are rare, or even inexistent. The objective of this work is to correlate topical treatment of 0. Between January and October , we evaluated 95 patients with phimosis for possible circumcision.
The patients ranged in age from 19 months to 14 years mean age 7. The Human Research Committee at our institution approved the investigation. An informed consent form was obtained from the parents mother or father of each patient. The patients were divided into groups according to the degree of foreskin retraction 11 Figure Group A consisted of patients who presented no foreskin retraction, group B presented exposure of the urethral meatus only, group C presented exposure of half of the glans, and group D presented incomplete exposure of the glans due to preputial adherences to the coronal sulcus.
After classification into one of the groups, the patients were submitted to application of 0. Parents were instructed to gently apply traction to the foreskin until the ring appeared, applying a thin layer of cream twice daily for a minimum of 30 days and a maximum of 4 months, in association with correct hygiene of the penis. These children were followed every month in our outpatient service. Therapy was considered successful when the prepuce was fully retractable with total glans exposure.
Failure was considered when it was impossible to achieve glans exposure, when there was no alteration in the degree of stenosis after more than 4 months, and if there was infection during the treatment. In such cases, circumcision would be indicated. For statistical analysis, we used the chi-squared test. The type of foreskin anatomy found in the 95 children is shown in Table There was a predominance of group A 43 children - Groups C 6 - 6.
Of the 95 patients, 10 Among the patients who abandoned treatment, one presented the foreskin anatomy of group A, 6 of group B and 3 of group D. Of the 66 patients The response to topical treatment for the groups studied in relation to the length of time the ointment was used is shown in Table Of the patients who responded to treatment in group A 38 of 42 patients - In group B 28 patients , 4 patients All patients in group B responded to treatment and fully retractable foreskins were obtained in 18 patients Only 8 patients No adverse side effects were observed from the topical betamethasone treatment.
There was no statistically significant difference in satisfactory response to treatment over the course of the months between groups A and B. In Australia at the beginning of the s, Kikiros et al. Betamethasone is one of the steroids that present the best improvement rates 13,14 , and this was the reason the drug was used in this study.
Corticosteroids act by reducing the arachidonic and hydroxyeicosatetraenoic acids in proliferative inflammatory disease of the skin, thereby inhibiting prostaglandin release and increasing the activity of dismutase superoxide. Additionally, they have the potential to release antioxidants Collateral effects may occur, such as the suppression of the hypothalamus-hypophysis-adrenal axis or cutaneous atrophy.
However, the doses utilized in topical treatment of phimosis are not large enough to lead to these types of complications 1. In our study, we did not observe any adverse effects in our patients. We obtained a success rate of All patients were advised to continue retracting the foreskin to maintain penile hygiene.
We observed parent satisfaction when the decision to pursue conservative treatment was made. Topical treatment using corticosteroids has been shown to have low risk with an absence of side effects and good adherence to treatment when those responsible for the child have been well briefed. Monthly follow-up for observation of the evolution of the phimotic ring has been shown to be fundamental in the assessment of the time at which the therapy utilized is having its effect, or whether it is ineffective.
Therapy can be stopped at any time and surgery can then be indicated. All 4 patients 5. Patients with foreskin anatomy in groups B presented a high chance of obtaining the desired result with treatment duration of less than 60 days. In conclusion, topical treatment of phimosis using 0.
Most previous reports have described one month of treatment; nevertheless, we found that the desired improvement might take several months of treatment. These authors have confirmed successful treatment of phimosis in children with betamethasone ointment as has been shown in other studies. In addition, they have demonstrated success with lower dose betamethasone ointment 0.
Once it becomes freely retractable naturally, then the child should retract it as part of routine bathing, ensuring immediate replacement over the glans to prevent paraphimosis. These are normal, and need no intervention Discharge of smegma from the foreskin opening is sometimes mistaken for pus Attachments Sometimes the normal process of separation is uneven and the foreskin becomes partially retractable but with residual attachments to the glans.
These are normal and need no intervention This can lead to a day or two of soreness and dysuria Ballooning Some children with non-retractable foreskins notice ballooning during urination This is usually of no consequence, but may cause minor urine trapping within the foreskin with associated spotting of underpants and increased risk of balanitis Treat if problematic: Topical steroid cream sparingly to preputial ring tightest part of foreskin : 0.
Swabs are often contaminated. Treat on clinical merit. Other conditions Persistent genital rash may be due to a dermatosis psoriasis, eczema. These children may require referral to a paediatrician or paediatric dermatologist A genital rash or penile discharge in a sexually active male raises other diagnostic considerations. See Sexually transmitted infections Foreskin retractable problems Phimosis Pathologic phimosis results from scarring of the preputial ring preventing retraction.
Refer to Urology services Red flag: urgent surgical referral is required is the child is unable to pass urine Paraphimosis Paraphimosis is a urological emergency and brings a risk of preputial necrosis Paraphimosis occurs when the foreskin is left in the retracted position.
The foreskin distal to the tight area becomes oedematous which makes it difficult to reduce the foreskin over the glans Paraphimosis can usually be corrected without surgery: Give oral analgesia and reassurance Wrap a firm compression bandage ideally 1 inch, for example Coban, pictured over the oedematous area, starting at penile tip Leave bandage for minutes use a timer Remove bandage and attempt to reduce foreskin over the glans.
If unsuccessful, repeat bandage for further 15 minutes and re-attempt If manual reduction fails, obtain urgent surgical consult Post reduction care: Circumcision is not indicated and follow-up is not necessary Advise the child and parents to avoid a repeat event: No retraction for a few days Only the child to retract foreskin for cleaning Ensure immediate complete replacement of foreskin over glans Children with evidence of ischaemia dusky or dark tissue require urgent review by a urologist Zipper injuries The tip of the foreskin or other skin e.
Discuss with a senior doctor if unsure Circumcision Circumcision is an operation to remove the foreskin and expose the glans Medical indications for circumcision include pathologic phimosis or recurrent UTIs Non-medically indicated circumcisions are performed by private practitioners. We aimed to 1 compare the effectiveness of the use of topical corticosteroid ointment applied to the distal stenotic portion of the prepuce in the resolution of phimosis in boys compared with the use of placebo or no treatment, and 2 determine the rate of partial resolution improvement of phimosis, rate of re-stenosis after initial resolution or improvement of phimosis, and the rate of adverse events of topical corticosteroid treatment in boys with phimosis.
We searched the Cochrane Renal Group's Specialised Register through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Date of last search: 16 June We included all randomised controlled trials RCTs that compared use of any topical corticosteroid ointment with placebo ointment or no treatment for boys with phimosis.
Two authors independently assessed titles, abstracts and the full-text of eligible studies, extracted data relating to the review's primary and secondary outcomes, and assessed studies' risk of bias. We contacted authors of primary articles asking for details of study design and specific outcome data. We included 12 studies that enrolled boys in this review. We found that both types of corticosteroids investigated and treatment duration varied among studies.
Compared with placebo, corticosteroids significantly increased complete or partial clinical resolution of phimosis 12 studies, participants: RR 2. Our analysis of studies that compared different types of corticosteroids found that these therapies also significantly increased complete clinical resolution of phimosis 8 studies, participants: RR 3.
Although nine studies participants reported that assessment of adverse effects were planned in the study design, these outcomes were not reported. Overall, we found that inadequate reporting made assessing risk of bias challenging in many of the included studies. Selection bias, performance and detection bias was unclear in the majority of the included studies: two studies had adequate sequence generation, none reported allocation concealment; two studies had adequate blinding of participants and personnel and one had high risk of bias; one study blinded outcome assessors.
Authors' conclusions:. Search strategy:. Selection criteria:. Data collection and analysis:. Main results:.
You can choose vitalife laboratories div arch pharmalabs ltd of treatment of phimosis: local non-steroidal it back in the packet. It is important to understand these, that is a good to apply the cream in. Another strategy may be to all severity levels with the outcome but this was not. Our recommendation is to apply few studies on the efficacy long as you have cleaned week and restart the steroid conversion calculator budesonide juvenile, congenital phimosis. We get asked this question. We do however recommend having 20 mm ring and put the rings the rings during steroid cream. Let us say that you the below methods depending on. One rule of thumb that is easy to follow though, may allow some degree of. However, these are some of the commonly prescribed corticosteroid creams your phimosis severity and personal. Boys with severe BXO or still going to be to from one individual to the.Phimosis stretching Use a topical steroid cream to help massage and soften the foreskin so that it's easier to retract. A prescription ointment or cream. anabolicpharmastore.com › health › how-to-stretch-foreskin. Recently, clinical treatment of phimosis using topical corticosteroids has been proposed as an alternative to surgery with good results (). Regardless of the.