Phimosis and topical steroids: new clinical findings

Abstract

Phimosis has been defined as unretractable foreskin without adherences and/or a circular band of tight prepuce preventing full retraction. The aim of this study is to evaluate the efficacy (response rate) of topical steroids for the treatment of tight phimosis at different age stages. After using the same medication with different dosage schemes, a retrospective analysis was carried out to assess the efficacy of topical steroids in the treatment of tight phimosis. Patients were divided into three groups: group A (betamethasone scheme A), group B (betamethasone scheme B) and group C (control group). Remission of phimosis, with a complete exposure and without a narrowing behind the glans, was considered a complete response to treatment. The outcomes were then related to dosage scheme and patient's age. The dosage for group A was more effective than the dosage for groups B and C (control group). Phimosis resolved in 90% (group A), 72% (group B) and 56% (group C) of cases. A successful treatment was closely related to the age of patients at the beginning of steroid application. The results showed that treatment with topical steroids, which in general gives good results, proved to be much more successful in patients aged between 4 and 8 years, suggesting the efficacy of an early beginning of the treatment.

Role of topical steroid in primary treatment of childhood phimosis

“…The percentage of treatment failure in our series is compatible with that of Zampieri et al at 4.0% and Golubovic et al at 5%. 13,14 The failure rate is much lower than Wai-Hung et al series results (14.8%). 15 Majority of patients (82.4%) responded within 4 weeks to topical steroid (0.05% betamethasone ointment).…”

Physiological phimosis-the tincture of time

“…This together with intermittent erections results in resolution of phimosis over time. 3,6,7,10 Present study has attempted to simplify the approach towards physiological phimosis. It is to be emphasized that no interventions or surgery should be advised in these young patients.…”

“…The factors might be balanitis, smegma, paraphimosis. 5,6 Physiological phimosis can usually be managed conservatively. 1,6,7 …”

Phimose

“…In einer Verlaufsbeobachtung über 6 Monate wurde 0,05%ige Betamethasonsalbe lokal jeweils 2-mal täglich über 1 Monat verabreicht und konnte nach Ende der Nachbeobachtungszeit eine Erfolgsrate von 77% zeigen [3].Prospektiv randomisierte wie retrospektive Studien [13,14] konnten für die topische Anwendung von Betamethasonsalbe Erfolgsraten um 80% eruieren, wobei die Anwendung topischer Steroide bei jüngeren Knaben wirkungsvoller zu sein scheint als bei einem Therapiebeginn im Alter von über 8 Jahren.…”

“…Als antifibrotischer Wirkmechanismus wird die Reduktion der Typ-I-und -III-Kollagen-Synthese diskutiert. Ferner inhibieren Steroide die Synthese von Glykosaminoglykanen, was "hautverdünnende" Effekte verursacht [13].…”