Objective To further test the application of topical steroids in boys referred to a paediatric surgical practice with pathological, non‐retractable foreskins diagnosed as phimosis. Patients and methods This prospective study comprised two groups of 20 boys each (mean age 4.1 years, range 3–6) diagnosed as having phimosis; twice daily, a topical steroid (0.05% betamethasone cream) was applied on the narrowed preputial skin in the first group and a neutral cream (Vaseline) in the second (control) group. Patients were treated for 4 weeks and the retractability of the foreskin and any side‐effects assessed. Results Good retraction of the foreskin was achieved in 19 patients treated with betamethasone cream and the response was unsatisfactory in 16 patients from the control group; these 16 boys and one 6‐year‐old boy treated with betamethasone were circumsized. There were no side‐effects or problems after the application of either cream. Conclusion Treatment with 0.05% betamethasone cream is a simple and safe method for the treatment of phimosis in boys older than 3 years. An early operation is necessary in cases of genuine phimosis when 1 month of treatment with topical steroids has failed. We strongly support the saying, ‘The fortunate foreskin of an infant boy will usually be left well alone by everyone but its owner’.

There are three different topics covered in the paediatric urology section in this issue. Authors from Belgrade describe how a dorsal dartos flap can be used to prevent fistula in the Snodgrass hypospadias repair. The use of extracorporeal pelvic floor magnetic stimulation in children with voiding dysfunction is described by authors from Seoul. And finally, authors from Antalya write about the impact of the location of the ureteric orifice on the efficacy of endoscopic injection to correct VUR. OBJECTIVE To evaluate the importance of urethral covering using vascularized dorsal subcutaneous tissue for preventing fistula in the Snodgrass hypospadias repair. PATIENTS AND METHODS The study included 67 children (aged 1–11 years) who had hypospadias repaired between April 1998 and May 2003, including 51 with distal and 16 with midshaft hypospadias. In all children, a standard tubularized incised‐plate urethroplasty was followed by reconstruction of new surrounding urethral tissue. A longitudinal dartos flap was harvested from excessive dorsal preputial and penile hypospadiac skin, and transposed to the ventral side by a buttonhole manoeuvre; it was sutured to the glans wings around the neomeatus, and to the corpora cavernosa over the neourethra. Thus the neourethra was completely covered with well‐vascularized subcutaneous tissue. RESULTS At a mean (range) follow‐up of 21 (6–65) months, the result was successful, with no fistula or urethral stenosis, in all 67 children. CONCLUSION We suggest that urethral covering should be part of the Snodgrass procedure. A dorsal well‐vascularized dartos flap, buttonholed ventrally, is a good choice for preventing fistula. Redundancy of the flap and its excellent vascularization depends on the harvesting technique.

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A variant of the onlay island flap urethroplasty in severe hypospadias repair is described. The principles of the technique include mobilization of the urethral plate without dividing it, release of chordee, creation of a pedicle island flap on the dorsal penile skin with redundant vascularized tissue that is transposed to the ventral side of the penis by a buttonhole maneuver, and onlay of the flap to the mobilized urethral plate, covering all suture lines with a wide pedicle of flap. During the last 3 years this operation was performed in 92 patients 12 months to 19 years old with severe hypospadias. The complication rate was 5%.