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Zhou G, Jiang M, Yang Z, Xu W, Li S. Efficacy of topical steroid treatment in children with severe phimosis in China: A long-term single centre prospective study. J Paediatr Child Health 2021; 57:1960-1965. [PMID: 34212436 PMCID: PMC9290972 DOI: 10.1111/jpc.15628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/08/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the efficacy of topical steroid (0.1% mometasone furoate) therapy and factors affecting long-term outcome of paediatric severe phimosis in China. METHODS A total of 1550 patients with severe phimosis classified by Kikiros system were prospectively enrolled in the study from January 2016 to February 2020. They were prescribed with 0.1% mometasone furoate twice a day for 4 weeks. Patients were re-evaluated at the end of weeks 2, 4, 8 and 6 months follow-up. RESULTS A total of 1499 patients completed the treatment, 71.1% responded at the end of week 4. The long-term success rate was 66.0% over a mean follow-up of 26.9 months. The success rate of grade 4 phimosis was significantly higher than that of grade 5 at 4, 8 weeks and 6 months (P = 0.005, P < 0.001 and P < 0.001, respectively). Patients with balanoposthitis had a poorer outcome compared with patients without symptoms and patients symptoms by prepuce ballooning or urinary tract infections (P < 0.001). Initial grade of 5 phimosis and symptom with balanoposthitis were independent risk factors for recurrence. All patients had no systemic side effects, 23 cases developed local erythema or burning sensation. CONCLUSION Topical steroid (0.1% mometasone furoate) is an effective treatment for severe phimosis in children. The recurrence was related to the grade or symptoms of severe phimosis.
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Affiliation(s)
- Guanglun Zhou
- Department of Urology and Laboratory of Pelvic Floor Muscle FunctionShenzhen Children's HospitalShenzhenChina
| | - Man Jiang
- Department of Infectious DiseaseShenzhen Children's HospitalShenzhenChina
| | - Zhilin Yang
- Department of Urology and Laboratory of Pelvic Floor Muscle FunctionShenzhen Children's HospitalShenzhenChina
| | - Wanhua Xu
- Department of Urology and Laboratory of Pelvic Floor Muscle FunctionShenzhen Children's HospitalShenzhenChina
| | - Shoulin Li
- Department of Urology and Laboratory of Pelvic Floor Muscle FunctionShenzhen Children's HospitalShenzhenChina
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Balaji BS, Jacob TJK, Gowri MS. Acceptability and outcomes of foreskin preservation for phimosis: An Indian perspective. J Family Med Prim Care 2020; 9:2297-2302. [PMID: 32754491 PMCID: PMC7380800 DOI: 10.4103/jfmpc.jfmpc_49_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/12/2020] [Accepted: 03/26/2020] [Indexed: 01/12/2023] Open
Abstract
Aim: Understanding the Indian perspective, effectiveness, and acceptability of prepuce conservation in children with phimosis. Circumcision is performed and recommended far too often for nonphysiological phimosis. Will a less radical approach be acceptable in the subcontinent? Method: A two-arm study with the first arm as KAP (knowledge, attitude, and practice) study (n = 502). The second arm recruited deserving boys (n = 47) with symptomatic phimosis (see inclusion criteria). Betamethasone ointment was applied twice daily over the foreskin and gently massaged to stretch the phimotic band. Those who failed were offered lateral preputioplasty or circumcision. Religious beliefs influence attitude and practice and these were looked at with subgroup analysis. Results: Most (85%) knew that circumcision was not the only treatment for phimosis. Though many parents (93%) knew the importance of foreskin cleanliness, few practiced it. The success of the steroid application was 81% (n = 38/47). Eight underwent preputioplasty. Minor discomfort as morbidity was noted. All parents were able to completely retract the foreskin of their children by the end of one month and were happy about the cosmetic result. Conclusions: KAP data on foreskin health is not available in the subcontinent, and this is a landmark study. Religious belief and community identity play a strong role in decisions related to foreskin preservation. Prepuce hygiene and knowledge about the usefulness of the foreskin is poor. The combination of medical and surgical methods of conserving the prepuce was effective. A high rate of success and the non-mutilating cosmetic result of prepuce preservation were acceptable to these parents.
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Affiliation(s)
- B S Balaji
- Department of Paediatric Surgery, CMC, Vellore, Tamil Nadu, India
| | | | - M S Gowri
- Department of Biostatistics, CMC, Vellore, Tamil Nadu, India
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Limited Dorsal Slit Preputialplasty for Management of Phimosis in Children. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1685-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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4
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Zebras in Foreskin Dermatopathology: A Review. J Low Genit Tract Dis 2019; 23:235-240. [PMID: 31149956 DOI: 10.1097/lgt.0000000000000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of the study was to review uncommon foreskin dermatopathology conditions clinically and pathologically. METHODS A database search of PubMed and Google Scholar were extracted between March 1, 2009, and March 1, 2019, using the search terms "foreskin," "prepuce," "penis," "pathology," "dermatology," and "rare." The search was limited to "humans" and "dermatopathology." Full article texts were reviewed. Reference lists were screened for additional articles. Patient details (diagnosis, dermatopathology, treatment, and follow-up if available) were extracted. We excluded articles written in the non-English language, unusual variants of common conditions, and cases of common dermatologic conditions. RESULTS A list of 369 articles was identified and another screening identified 30 articles for rare foreskin pathologies. Those are divided into categories based on the following etiologies: (a) benign, including congenital (e.g., aposthia), infectious (graft versus host disease and histoplasma), autoimmune (Crohn's disease and pyoderma gangrenosum), and benign neoplasms (neurofibroma, apocrine hidrocystoma, verruciform xanthoma, porokeratosis, penile cutaneous horn, localized amyloidosis) and (b) malignancies, including primary (myeloid sarcoma, basal cell carcinoma, Kaposi's sarcoma, mucosal-associated lymphoid tissue lymphoma), and metastasis. CONCLUSIONS We reviewed and discussed unusual benign and malignant dermatopathology conditions that can affect the foreskin.
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Sabino Borges LG, Meirelles MF, Bernardes N, de Castro FL, Helmo FR, Rocha LP, Antunes Teixeira VDP, Miranda Correa RR. Evaluation of topical corticosteroids in children with phimosis through morphological and immunohistochemical analyses of the foreskin. Afr J Paediatr Surg 2019; 16:17-22. [PMID: 32952135 PMCID: PMC7759080 DOI: 10.4103/ajps.ajps_119_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Histopathological analysis of the foreskin has become more common in the last two decades. OBJECTIVES This study aims to analyze the morphology of the foreskin and determine the effects of topical corticosteroid therapy on this tissue. MATERIALS AND METHODS We retrospectively evaluated forty foreskin samples from children aged from 2 years to 15 years with phimosis undergoing circumcision at our institution over a 2-year period. In the foreskin samples, we analyzed the elastic fibers (Verhoeff), epidermal thickness (hematoxylin and eosin), and Annexin 1 and Langerhans cells (LCs) (immunohistochemistry). RESULTS In the present study, 18 (45%) patients made use of topical corticosteroids, and 22 (55%) did not, while 4 (10%) had a history of balanoposthitis as previous complication. Forty patients were divided according to the parameter analyzed: with or without previous complication and with or without previous topical corticotherapy. Annexin 1 expression was significantly higher in group with a history of complications when compared with group without complications (P = 0.024) and lower in the group of those who used corticosteroids when compared with those who did not used corticosteroids (P = 0.364). In the analysis of all samples, the density of mature LCs was significantly higher when compared with immature LCs (P < 0.0001). The density of immature LCs was significantly higher in patients without previous complications when compared with group with complications (P = 0.028). CONCLUSIONS These findings contribute to a better understanding of the histopathological aspects of previous complications and of treatment with corticosteroids in children with phimosis.
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Affiliation(s)
- Luis Gustavo Sabino Borges
- General Pathology Division, Biological and Natural Sciences Institute, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Maria Flávia Meirelles
- General Pathology Division, Biological and Natural Sciences Institute, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Natália Bernardes
- General Pathology Division, Biological and Natural Sciences Institute, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Felipe Lopes de Castro
- General Pathology Division, Biological and Natural Sciences Institute, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Fernanda Rodrigues Helmo
- General Pathology Division, Biological and Natural Sciences Institute, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Laura Penna Rocha
- General Pathology Division, Biological and Natural Sciences Institute, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Vicente de Paula Antunes Teixeira
- General Pathology Division, Biological and Natural Sciences Institute, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Rosana Rosa Miranda Correa
- General Pathology Division, Biological and Natural Sciences Institute, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
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Lourenção PLTDA, Queiroz DS, de-Oliveira WE, Comes GT, Marques RG, Jozala DR, Ortolan EVP. Observation time and spontaneous resolution of primary phimosis in children. ACTA ACUST UNITED AC 2018; 44:505-510. [PMID: 29019581 DOI: 10.1590/0100-69912017005013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/22/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE to investigate spontaneous resolution rate of a series of patients with physiologic phimosis in relation to observation time and presence of symptoms. METHODS retrospective and longitudinal follow-up study of patients with physiologic phimosis, that did not apply topic treatment. These patients were invited for a new visit for reevaluation, or recent data were obtained by chart analysis. Spontaneous resolution rate was determined and statistically compared to age, presence of symptoms at first medical visit and time until reevaluation. RESULTS seventy one patients were included. Medium time of observation from first visit to reevaluation was 37.4 months. There was spontaneous resolution of phimosis in 32 (45%) patients. Children with spontaneous resolution were younger at initial diagnosis and were observed during a longer period of time. Most asymptomatic patients at first visit presented spontaneous resolution. However, it was not possible to stablish a significant relationship between presence of symptoms and evolution of physiologic phimosis. CONCLUSIONS time of observation was the main determinant of spontaneous resolution of patients with physiologic phimosis, reinforcing the current more conservative approach regarding circumcision of those patients.
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Affiliation(s)
| | - Dênis Silva Queiroz
- - Botucatu School of Medicine (UNESP), Pediatric Surgery Division, Department of Surgery and Orthopedics, Botucatu, São Paulo, Brazil
| | - Wilson Elias de-Oliveira
- - Botucatu School of Medicine (UNESP), Pediatric Surgery Division, Department of Surgery and Orthopedics, Botucatu, São Paulo, Brazil
| | - Giovana Tuccille Comes
- - Botucatu School of Medicine (UNESP), Pediatric Surgery Division, Department of Surgery and Orthopedics, Botucatu, São Paulo, Brazil
| | - Rozemeire Garcia Marques
- - Botucatu School of Medicine (UNESP), Pediatric Surgery Division, Department of Surgery and Orthopedics, Botucatu, São Paulo, Brazil
| | - Débora Rodrigues Jozala
- - Botucatu School of Medicine (UNESP), Pediatric Surgery Division, Department of Surgery and Orthopedics, Botucatu, São Paulo, Brazil
| | - Erika Veruska Paiva Ortolan
- - Botucatu School of Medicine (UNESP), Pediatric Surgery Division, Department of Surgery and Orthopedics, Botucatu, São Paulo, Brazil
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Dave S, Afshar K, Braga LH, Anderson P. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version). Can Urol Assoc J 2018; 12:E76-E99. [PMID: 29381458 PMCID: PMC5937400 DOI: 10.5489/cuaj.5033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Sumit Dave
- Department of Surgery (Urology), Western University, London, ON; Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC; Canada
| | - Luis H. Braga
- Department of Surgery (Urology), McMaster University, Hamilton, ON; Canada
| | - Peter Anderson
- Department of Urology, Dalhousie University, Halifax, NS; Canada
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Abstract
OBJECTIVE To evaluate the functional and cosmetic result of modified-triple incision preputial plasty for surgical management of phimosis in children. MATERIALS AND METHODS This prospective study involved all consecutive children (age 3-15) with phimosis, managed at our Institution in a one-year period. All patients unable to retract the foreskin and symptomatic with episodes of posthitis or balanoposthitis or ballooning of the foreskin with voiding were initially included. After a two-month trial of topic corticosteroids treatment, for patients refractory to conservative ointment treatment, "trident" preputial plasty was offered. This procedure combines two lateral Z-plasty and one middle Y-V plasty. All the procedures were performed as a day care, in general anaesthesia by two senior surgeons. Outpatient follow-up controls were scheduled at 1 and 2 week, 1, 6 and 12 months after surgery, respectively. RESULTS A total of 41 patient were enrolled. Mean operative time was 24 minutes (range 15-43). At 12-month follow-up, all but one patients (97.6%) was able to retract the prepuce. Cosmetic and functional results were satisfactory. CONCLUSION In selected group of children with phimosis, the "trident" preputial plasty provided excellent cosmetic and functional result. Adequate retraction of the prepuce by the patients soon after surgery is mandatory.
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Binet A, François-Fiquet C, Bouche-Pillon MA. [Review of clinical experience for a new preputioplasty technique as circumcision alternative]. ANN CHIR PLAST ESTH 2015; 61:23-8. [PMID: 25708731 DOI: 10.1016/j.anplas.2015.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/26/2015] [Indexed: 11/25/2022]
Abstract
Surgery is required for phimosis with a contracted fibrous ring or when the medical treatment with steroids has been unsuccessful. Surgical teams often opt for circumcision when a conservative technique can be used. This surgery could have some psychologic consequences, and when the circumcision in not according to religious convictions, it cannot be live well for the patient and his family. Furthermore, some surgery procedures for prepuce conservation seem to give some unaesthesics aspects with cutaneous excess. The objective of this study was to evaluate our new preputioplasty technique according to the initial diagnosis (phimosis with scarred foreskin or long and narrow foreskin), in situation where circumcision is required currently. Outcome evaluated was: easy and painless foreskin retraction, absence of postoperative phimosis as well as cosmetic aspects of the penis. In this study, 90 children benefited from this technique and subsequent follow-up. The mean age was 7.9 years for the 32 children in the sclerotic phimosis group and 6.8 years for the 58 children in the long and narrow foreskin group. We observed complete foreskin retraction without any recurrence in 100% of children with a phimosis resistant to medical treatment which consisted of progressive foreskin retraction and application of topical steroids, with a mean postoperative follow-up of 1.4 years. Results showed an excellent cosmetic aspect of the penis with absence of enlarged foreskin in all our subjects. This study underlines the relevance of this surgical technique.
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Affiliation(s)
- A Binet
- Service de chirurgie pédiatrique, American memorial hospital, 43, rue Cognacq-Jay, 51092 Reims, France.
| | - C François-Fiquet
- Service de chirurgie pédiatrique, American memorial hospital, 43, rue Cognacq-Jay, 51092 Reims, France; Service de chirurgie plastique et reconstructrice, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims, France
| | - M A Bouche-Pillon
- Service de chirurgie pédiatrique, American memorial hospital, 43, rue Cognacq-Jay, 51092 Reims, France
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Lee CH, Lee SD. Effect of topical steroid (0.05% clobetasol propionate) treatment in children with severe phimosis. Korean J Urol 2013; 54:624-30. [PMID: 24044098 PMCID: PMC3773594 DOI: 10.4111/kju.2013.54.9.624] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 06/27/2013] [Indexed: 11/28/2022] Open
Abstract
Purpose We report our experience with the use of a topical steroid, 0.05% clobetasol propionate, for the treatment of phimosis with clinical complications. Materials and Methods This was a retrospective analysis of the clinical outcomes of all patients presenting with phimosis to a single institution during the time period from October 2008 to May 2012. A total of 88 patients who had a Kikiros retractability grade of 4 or 5 and phimosis-associated clinical complications, such as ballooning of the prepuce, balanoposthitis, or a history of urinary tract infection (UTI), were instructed to apply 0.05% clobetasol propionate cream to the slightly retracted foreskin and to massage gently while retracting the foreskin. The efficacy of treatment was evaluated at 4 weeks from the initiation of therapy. Results A total of 60 of the 88 patients (68.2%) showed a complete response (i.e., full retraction of the foreskin) to the therapy. The phimotic ring disappeared in 25 of the 88 patients (28.4%) after treatment. Patients who had a history of balanoposthitis, smegma, ballooning of the prepuce, or UTI showed significantly poorer improvement in preputial retraction (p<0.001, p<0.001, p<0.001, and p=0.02, respectively) and phimotic ring disappearance (p<0.001, p=0.001, p<0.001, and p=0.001, respectively) after treatment. No significant local or systemic side effects were associated with the administration of topical steroids. Conclusions Topical application of 0.05% clobetasol propionate cream and skin stretching is a safe, simple, and effective procedure with no significant side effects for severe phimosis in prepubertal boys.
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Affiliation(s)
- Chan Ho Lee
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea
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Affiliation(s)
- Andrew E Macneily
- Head, Division of Pediatric Urology, Department of Urological Sciences, University of British Columbia, Vancouver, BC
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12
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Sabino Borges LG, Perez-Bóscollo AC, Rocha LP, Silva RCR, Guimarães CSDO, Castro ECDC, Corrêa RRM. Foreskin analysis of circumcised boys with and without previous topical corticosteroid. Fetal Pediatr Pathol 2012; 31:265-72. [PMID: 22432721 DOI: 10.3109/15513815.2012.659381] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Problems with the foreskin are common reasons for pediatric surgery consultations. We collected the foreskin of 40 patients for 2 years and these samples were divided into groups with and without previous topical corticosteroid. We carried out histochemical hematoxylin & eosin and Picrosirius analyses of the foreskin. Collagen fibers and inflammatory infiltrate was higher in samples from patients who had complications related to phimosis. Fibrosis was higher in patients who used topical corticosteroid. A histopathologic study of the foreskin may provide an additional analysis of patients undergoing circumcision and it can also improve the accuracy of surgical indication.
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Kuehhas FE, Miernik A, Sevcenco S, Tosev G, Weibl P, Schoenthaler M, Lassmann J. Predictive Power of Objectivation of Phimosis Grade on Outcomes of Topical 0.1% Betamethasone Treatment of Phimosis. Urology 2012; 80:412-6. [DOI: 10.1016/j.urology.2012.04.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/21/2012] [Accepted: 04/27/2012] [Indexed: 11/25/2022]
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Shahid SK. Phimosis in children. ISRN UROLOGY 2012; 2012:707329. [PMID: 23002427 PMCID: PMC3329654 DOI: 10.5402/2012/707329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/19/2011] [Indexed: 11/23/2022]
Abstract
Phimosis is nonretraction of prepuce. It is normally seen in younger children due to adhesions between prepuce and glans penis. It is termed pathologic when nonretractability is associated with local or urinary complaints attributed to the phimotic prepuce. Physicians still have the trouble to distinguish between these two types of phimosis. This ignorance leads to undue parental anxiety and wrong referrals to urologists. Circumcision was the mainstay of treatment for pathologic phimosis. With advent of newer effective and safe medical and conservative surgical techniques, circumcision is gradually getting outmoded. Parents and doctors should a be made aware of the noninvasive options for pathologic phimosis for better outcomes with minimal or no side-effects. Also differentiating features between physiologic and pathologic phimosis should be part of medical curriculum to minimise erroneous referrals for surgery.
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Affiliation(s)
- Sukhbir Kaur Shahid
- Consultant Pediatrician and Neonatologist, Shahid Medical Centre, Mumbai-400 077, India
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15
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Reddy S, Jain V, Dubey M, Deshpande P, Singal AK. Local steroid therapy as the first-line treatment for boys with symptomatic phimosis - a long-term prospective study. Acta Paediatr 2012; 101:e130-3. [PMID: 22103624 DOI: 10.1111/j.1651-2227.2011.02534.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Phimosis is a common paediatric urological disorder and often necessitates circumcision. We prospectively evaluated local steroid therapy (LST) as the first choice therapy for such children. METHODS Two hundred and sixty symptomatic boys up to 15 years of age (mean 34 months) with phimosis were started on betamethasone dipropionate (0.05%) application on gently stretched prepuce twice a day. Follow-up visits were arranged at the end of weeks 1, 2 and 4 and 6 months. Grade of phimosis was objectively graded. RESULTS Ninety one percent of the boys showed a successful outcome at the end of 4 weeks; 72% responded in first week, further 16% responded in week 2, and only 2.6% achieved alleviation of phimosis on further application of LST beyond 2 weeks. Fourty two (17.8%) boys had a recurrence of phimosis on a long-term follow-up (mean - 25.4 months, range 6-48 months); thus, the long-term success rate was 77%, while 60 (23%) boys underwent surgery. CONCLUSION Local steroid therapy is safe and successful in alleviating symptomatic tight foreskin in a large majority of children. The response can be seen as early as 1 week; most of the children respond by week 2 and continuing therapy further may not be very effective.
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Affiliation(s)
- Srinath Reddy
- Department of Pediatrics, MGM University of Health Sciences, Navi Mumbai, India
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McGrath NA, Howell JM, Davis JE. Pediatric genitourinary emergencies. Emerg Med Clin North Am 2011; 29:655-66. [PMID: 21782080 DOI: 10.1016/j.emc.2011.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Pediatric medical complaints and differential diagnoses often vary from adults, requiring a specialized knowledge base and behavioral skill set. This article addresses a variety of congenital and acquired pediatric genitourinary disorders. Genitourinary emergencies include paraphismosis, priapism, serious infection, significant traumatic injury and gonadal torsion.
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Affiliation(s)
- Norine A McGrath
- Department of Emergency Medicine, Georgetown University Hospital, Washington Hospital Center, Washington, DC 20007, USA.
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Vorilhon P, Martin C, Pereira B, Clément G, Gerbaud L. [Assessment of topical steroid treatment for childhood phimosis: review of the literature]. Arch Pediatr 2011; 18:426-31. [PMID: 21354771 DOI: 10.1016/j.arcped.2011.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 10/30/2010] [Accepted: 01/22/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Questions concerning nonretractile foreskin are frequently asked by parents in infant consultations. Topical steroid treatment could be a less expensive and less traumatizing alternative to surgery. AIM To assess the effectiveness of topical steroid therapy in boys with phimosis. METHODS Literature review. All randomized controlled trials were selected, using the following research sources: Medline, Cochrane Library, Pascal, Embase, Blackwell Science, Google, Google scholar, SUDOC, international register of trials, and congress abstracts. Unpublished trials were also searched. The trials were analyzed using the ANAES guide from a therapeutic article. RESULTS Seven randomized controlled trials (n=714 patients) were in accordance with the inclusion criteria. The patients were between 1 and 12 years old. The treatment lasted for 4-8 weeks. The success rate at the end of the study was higher with the steroid (53.8-95%) than with the placebo (6.25-52%), P<0.05 for 6 randomized control trials. DISCUSSION According to the ANAES criteria, the level of scientific evidence is low (gradeC) because of the lack of power in clinical trials and numerous methodological shortcomings and biases, even when examining both randomized control trials and nonrandomized trials. Only a few local side effects were noted. CONCLUSION The use of topical steroids can be recommended in first-intention treatment before surgery for the management of phimosis.
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Affiliation(s)
- P Vorilhon
- Département de médecine générale, UFR de Clermont-Ferrand, Clermont-Ferrand, France.
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Pileggi F, Martinelli C, Tazima M, Daneluzzi J, Vicente Y. Is Suppression of Hypothalamic-Pituitary-Adrenal Axis Significant During Clinical Treatment of Phimosis? J Urol 2010; 183:2327-31. [DOI: 10.1016/j.juro.2010.02.2385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Indexed: 10/19/2022]
Affiliation(s)
- F.O. Pileggi
- Division of Pediatric Surgery, Department of Surgery and Anatomy, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - C.E. Martinelli
- Department of Pediatrics, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - M.F.G.S. Tazima
- Division of Pediatric Surgery, Department of Surgery and Anatomy, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - J.C. Daneluzzi
- Department of Pediatrics, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Y.A.M.V.A. Vicente
- Division of Pediatric Surgery, Department of Surgery and Anatomy, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Méndez-Gallart R, Estévez E, Bautista A, Rodríguez P, Taboada P, Armas AL, Pradillos JM, Varela R. Bipolar scissors circumcision is a safe, fast, and bloodless procedure in children. J Pediatr Surg 2009; 44:2048-53. [PMID: 19853772 DOI: 10.1016/j.jpedsurg.2009.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 05/11/2009] [Accepted: 06/01/2009] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study is to evaluate bipolar scissors circumcision by comparing it with standard freehand scalpel procedure. PATIENTS AND METHODS Data were analyzed from a prospective, randomized study, comparing 2 different surgical techniques for pediatric circumcision: the bipolar diathermy scissors circumcision technique with those of a conventional scalpel technique. A total of 230 pediatric patients younger than 16 years (115 in each arm of the trial) who were undergoing circumcision were reviewed prospectively. Operative time, surgical bleeding, complications, and postoperative morbidity were analyzed. Differences between bipolar scissors circumcision and conventional surgery were compared. RESULTS Median blood loss for bipolar circumcision was 0.2 mL (range, 0-0.8 mL) compared with 2.1 mL in the standard group (range, 0.9-4.2 mL) (P < .001). Operative time in the bipolar diathermy treated group was significantly decreased compared with conventionally treated patients (10.8 +/- 1.2 vs 19.1 +/- 2.6 minutes; P < .01). Early and late postoperative morbidity were significantly decreased in circumcised patients who underwent the bipolar circumcision technique as compared with those who underwent the conventional approach regardless of the postoperative edema (22 vs 10; P = .02). CONCLUSIONS Bipolar scissors circumcision approach is an effective and safe procedure alternative to the standard scalpel technique in pediatric circumcision with no significant morbidity.
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Affiliation(s)
- Roberto Méndez-Gallart
- Department of Pediatric Surgery, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain.
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Letendre J, Barrieras D, Franc-Guimond J, Abdo A, Houle AM. Topical Triamcinolone for Persistent Phimosis. J Urol 2009; 182:1759-63. [DOI: 10.1016/j.juro.2009.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Indexed: 10/20/2022]
Affiliation(s)
- Julien Letendre
- Department of Surgery, Division of Pediatric Urology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montreal, Montreal, Quebec, Canada
| | - Diego Barrieras
- Department of Surgery, Division of Pediatric Urology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montreal, Montreal, Quebec, Canada
| | - Julie Franc-Guimond
- Department of Surgery, Division of Pediatric Urology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montreal, Montreal, Quebec, Canada
| | - Ala Abdo
- Department of Surgery, Division of Pediatric Urology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montreal, Montreal, Quebec, Canada
| | - Anne-Marie Houle
- Department of Surgery, Division of Pediatric Urology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montreal, Montreal, Quebec, Canada
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Lund L, Wai KH, Mui LM, Yeung CK. An 18-month follow-up study after randomized treatment of phimosis in boys with topical steroid versus placebo. ACTA ACUST UNITED AC 2009; 39:78-81. [PMID: 15764277 DOI: 10.1080/00365590410002519] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the treatment of phimosis using topical steroid. MATERIAL AND METHODS This was a follow-up study after a prospective, randomized, double-blind study. A total of 137 boys with phimosis were randomly assigned to either betamethasone treatment or placebo for 4 weeks, with application of the cream twice daily. Non-responders to treatment were offered steroid treatment for a further 4 weeks. All patients were invited to a follow-up examination after 18 months. RESULTS The mean pre-treatment phimosis grades in the steroid and control groups were 5.08+/-0.66 and 4.97+/-0.70, respectively. At the 4-week follow-up, 49 boys (74%) in the steroid group were cured, compared to only 31 (44%) in the control group. Fourteen boys were circumcised after another 4 weeks of treatment; 43 of the remaining 57 boys (17 in the steroid group; 40 in the control group) had been cured. After a total of 92 boys took part in the 18-month follow-up study: 79 had been cured and 13 had suffered a relapse. Twenty-six patients did not took part in the follow-up investigation. No side-effects were noted. CONCLUSIONS When treatment is necessary for phimosis, we recommend application of topical steroid as first-line treatment because surgery can then be avoided in 85% of cases. This first randomized, double-blind, follow-up study shows that the treatment effect persists for at least 18 months.
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Affiliation(s)
- L Lund
- Department of Urology, Viborg Hospital, Viborg, Denmark.
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Is neonatal circumcision clinically beneficial? Argument against. NATURE CLINICAL PRACTICE. UROLOGY 2009; 6:74-5. [PMID: 19153572 DOI: 10.1038/ncpuro1292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 12/05/2008] [Indexed: 11/08/2022]
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Munro NP, Khan H, Shaikh NA, Appleyard I, Koenig P. Y-V Preputioplasty for Adult Phimosis: A Review of 89 Cases. Urology 2008; 72:918-20. [DOI: 10.1016/j.urology.2008.06.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 06/19/2008] [Accepted: 06/30/2008] [Indexed: 10/21/2022]
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Palmer LS, Palmer JS. The Efficacy of Topical Betamethasone for Treating Phimosis: A Comparison of Two Treatment Regimens. Urology 2008; 72:68-71. [DOI: 10.1016/j.urology.2008.02.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 02/03/2008] [Accepted: 02/16/2008] [Indexed: 11/16/2022]
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Esposito C, Centonze A, Alicchio F, Savanelli A, Settimi A. Topical steroid application versus circumcision in pediatric patients with phimosis: a prospective randomized placebo controlled clinical trial. World J Urol 2008; 26:187-90. [DOI: 10.1007/s00345-007-0231-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 11/27/2007] [Indexed: 10/22/2022] Open
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Abstract
It is important to plan for the future provision of paediatric surgery and anaesthesia
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Affiliation(s)
- Stuart Tanner
- University of Sheffield, Academic Unit of Child Health, Sheffield Children's NHS Trust, Western Bank, Sheffield, UK.
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Suzuki D, Kobayashi R, Kaneda M, Sato T, Ichikawa M, Ariga T. Severe phimosis as a notable sequela of allogeneic stem cell transplantation in boys. Bone Marrow Transplant 2007; 40:335-8. [PMID: 17572709 DOI: 10.1038/sj.bmt.1705738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hematopoietic SCT has improved the survival rates of patients with hematologic and metabolic disorders, as well as those with malignancy or immunodeficiency. Although various complications have been reported following allogeneic SCT, phimosis has rarely been reported, and the predisposing risk factors for phimosis have not been determined. In this study, the occurrence of severe phimosis following allogeneic SCT in boys was analyzed, and its risk factors were determined. The patients were under 15 years of age. Phimosis was observed in 32.6% of 46 patients after allogeneic SCT; 13.0% of cases required surgery. On univariate analysis, risk factors for severe phimosis included chronic GVHD and the use of a conditioning regimen including anti-thymocyte globulin (ATG). Multivariate analysis showed that chronic GVHD was an independent risk factor for severe phimosis. Thus, severe phimosis is an important complication of SCT in boys, especially in patients with chronic GVHD.
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Affiliation(s)
- D Suzuki
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, North 15-West 7, Kita-ku, Sapporo 060-8638, Japan.
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Zampieri N, Corroppolo M, Zuin V, Bianchi S, Camoglio FS. Phimosis and topical steroids: new clinical findings. Pediatr Surg Int 2007; 23:331-5. [PMID: 17308904 DOI: 10.1007/s00383-007-1878-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2007] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Nicola Zampieri
- Department of Surgical Sciences, Paediatric Surgical Unit, University of Verona, Verona, Italy.
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Nieuwenhuijs JL, Dik P, Klijn AJ, de Jong TPVM. Y-V plasty of the foreskin as an alternative to circumcision for surgical treatment of phimosis during childhood. J Pediatr Urol 2007; 3:45-7. [PMID: 18947698 DOI: 10.1016/j.jpurol.2006.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2006] [Accepted: 01/26/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the result of Y-V preputioplasty and to compare this with an earlier technique of prepuce-sparing phimosis treatment. MATERIALS AND METHODS A total of 65 boys were treated surgically for phimosis without removing the foreskin. Indications were the failure of conservative ointment treatment, congenital uropathies (to prevent infections and to make proper cleaning of the glans and the inner preputium possible to ensure clean urine sampling), recurrent balanitis or painful ballooning of the prepuce, and/or the need for urethral instrumentation. Forty-seven patients were treated with one or two Y-V plasties to widen the narrow preputial ring; 18 were treated using transverse closure of longitudinal incisions of the narrow preputial ring. RESULTS Of the 47 Y-V plasties, two patients had recurring complaints and needed further treatment (4.3%), and of the 18 patients treated by transversely closed longitudinal incisions, two patients had recurring complaints (11%). Recurrences occurred regardless of age and premedication with topical therapy. Cosmesis was considered to be excellent in all cases of Y-V plasty. Few patients complained about skin tags after longitudinal incisions. CONCLUSION Y-V plasty of the preputial skin as an alternative to circumcision in the treatment of phimosis has good functional and cosmetic results. It is a minor operation with less impact on the penis than partial or total circumcision. The cosmetic results are superior to those after transversely closed longitudinal incisions.
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Affiliation(s)
- Jaap L Nieuwenhuijs
- University Children's Hospital, University Medical Centre Utrecht, The Netherlands
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Morris BJ, Castellsague X, Bailis SA. Re: cost analysis of neonatal circumcision in a large health maintenance organization. J Urol 2007; 176:2315-6; author reply 2317-9. [PMID: 17070332 DOI: 10.1016/j.juro.2006.07.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Indexed: 10/24/2022]
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Ku WH, Chiu BSK, Huen KF. Outcome and recurrence in treatment of phimosis using topical betamethasone in children in Hong Kong. J Paediatr Child Health 2007; 43:74-9. [PMID: 17207060 DOI: 10.1111/j.1440-1754.2007.01006.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To study the efficacy of treating phimosis with topical steroid, and its long-term outcome and side effects. We also looked into the effect of daily retraction and cleansing of prepuce on preventing recurrence of phimsosis. METHODS This prospective study comprised 138 boys who were prescribed 0.05% betamethasone ointment (Diprocel) during 1 August 2001-31 July 2004. Five boys were excluded because of non-compliance. Of the remaining 133 boys, 108 were followed-up and assessed. Age ranged from 0.03 to 12.9 years (mean=3.38, SD=2.79). The number of treatment course received, short-term and long-term outcome, side effects and the effect of daily foreskin retraction were studied. RESULTS The success rate of first treatment course was 81.5%, and 60.2% of boys remained free from phimosis upon latest assessment. The follow-up period ranged from 0.4 to 4.4 years (mean=2.45, SD=0.90). There were no side effects noted. We found a significant and linear relationship between daily foreskin retraction and sustained resolution of phimosis. CONCLUSION Topical steroid is an effective and safe treatment for phimosis, especially when combined with a good hygiene practice of the foreskin with daily cleansing and retraction. A trial of topical steroid treatment should be offered upon considering circumcision.
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Affiliation(s)
- Wai-Hung Ku
- Department of Paediatrics and Adolescent Medicine, Tseung Kwan O Hospital, Hong Kong SAR, China.
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Garcia de Freitas R, Nobre YD, Demarchi GTS, Hachul M, Macedo A, Srougi M, Ortiz V. Topical treatment for phimosis: time span and other factors behind treatment effectiveness. J Pediatr Urol 2006; 2:380-5. [PMID: 18947640 DOI: 10.1016/j.jpurol.2006.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Accepted: 05/02/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the factors that may influence the effectiveness of 0.2% betamethasone/hyaluronidase cream in the treatment of phimosis. METHODS We treated 427 patients (3-10 years old, mean 6.33) in a prospective, randomized, blind study, with 214 patients on a 4-week and 213 patients on an 8-week course. All patients were seen once monthly at least for 6 months after the end of treatment. The penis was photographed to allow objective evaluation of treatment response. The therapeutic response was graded as total success when there was complete exposure of the glans; partial success when there was exposure of half of the glans, impeded by balanopreputial adherence or ring fibrosis at the prepuce; and therapeutic failure when patients had no or less than 50% glans exposure. RESULTS After treatment 92.1% of patients showed total or partial success, but during follow up (mean 9.36 months, range 6-13) 29.5% failed to maintain this (22.6% and 37.6% for 8- and 4-week treatment, respectively). During treatment, 13.6% presented side effects or complications: prepuce ardor (6.1%), hyperemia (4.6%), paraphimosis (0.0098%). Intervention or interruption of treatment was unnecessary. The two groups were statistically similar in all parameters, but time of treatment=8 weeks, previous urethral meatal exposure and no previous balanoposthitis increased the chance of total success. Surgery was indicated for failure or relapse in 181 patients (42.38%). CONCLUSION Treatment with topical 0.2% betamethasone/hyaluronidase cream for 8 weeks is effective and safe, especially if the urethral meatus is exposed and there is no previous balanoposthitis. Rescue treatment is not recommended, as the results were not encouraging.
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Lee JW, Cho SJ, Park EA, Lee SJ. Topical hydrocortisone and physiotherapy for nonretractile physiologic phimosis in infants. Pediatr Nephrol 2006; 21:1127-30. [PMID: 16791612 DOI: 10.1007/s00467-006-0104-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Revised: 01/04/2006] [Accepted: 01/05/2006] [Indexed: 10/24/2022]
Abstract
The effect of hydrocortisone (HC), the steroid of lowest potency, and physiotherapy (PT) on non-retractile physiologic phimosis (PP) and the reduction of subsequent recurrent UTI was evaluated in male infants with UTI. Seventy-eight male infants with febrile UTI and nonretractile PP were prospectively randomized into HC (Plancol, n=39) and control (Vaseline, n=39) groups. Topical application of HC as a thin film around the preputial margin twice a day for four weeks with PT was instructed. The response rate in the HC group was 89.7% (35/39), which was significantly higher than the rate (20.5%; 8/39) in the control group (P<0.05). In the HC group, the response rate was much higher (96.1%) in the subgroup with PT than in the group without PT. Most of the response (88.5%) was observed within two weeks. During the following year, the recurrent rate of UTI was 7.1% (2/28) in the infants with retractile prepuces, which was significantly less than than the rate (29.6%; 8/27) in infants with nonretractile prepuces (P<0.05). In conclusion, topical HC and PT for 2-4 weeks proved to be a simple, safe and effective treatment for nonretractile PP in infants with UTI, and this procedure was beneficial in reducing recurrent UTI.
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Affiliation(s)
- Jung Won Lee
- Department of Pediatrics, Seoul Municipal Dongbu Hospital, Seoul, South Korea
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Abstract
In the last decade, significant progress in the knowledge and management of external genital anomalies has been achieved, including an improved understanding of epidemiology and pathophysiology of these anomalies, the identification of etiologic genetic defects, and significant improvements in surgical approaches that have decreased complications and improved cosmetic outcomes. We highlight the most clinically important advances of the commonly encountered external genital anomalies.
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Affiliation(s)
- Dawn L MacLellan
- Department of Urology, Dalhousie University Medical School, 5850-5890 University Avenue, PO Box 9700, Halifax, Nova Scotia, Canada B3K 6R8.
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Marques TC, Sampaio FJB, Favorito LA. Treatment of phimosis with topical steroids and foreskin anatomy. Int Braz J Urol 2006; 31:370-4; discussion 374. [PMID: 16137407 DOI: 10.1590/s1677-55382005000400012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2005] [Accepted: 06/20/2005] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To correlate topical steroidal treatment of stenosed foreskin with the different degrees of glans exposure and the length of time the ointment is applied. MATERIALS AND METHODS We studied 95 patients with phimosis, divided according to the degree of foreskin retraction. Group A presented no foreskin retraction, group B presented exposure of only the urethral meatus, group C presented exposure of half of the glans, and group D presented exposure of the glans, which was incomplete because of preputial adherences to the coronal sulcus. Patients were submitted to application of 0.05% betamethasone ointment on the distal aspect of the prepuce twice daily for a minimum of 30 days and a maximum of 4 months. RESULTS Of 95 patients, 10 (10.52%) abandoned the treatment and 15 patients in groups C and D were excluded from the study. Among the remaining 70 patients, only 4 patients (5.7%) in group A did not obtain adequate glans exposure after treatment. In group A (38 patients), fully retractable foreskins were obtained in 19 patients (50%) after 1 month of treatment. In group B (28 patients), fully retractable foreskins were obtained in 18 patients (64.2%) after 1 month. CONCLUSIONS Treatment was successful in 94.2% of patients, irrespective of the type of foreskin anatomy. The improvement may require several months of treatment. Patients with impossibility of urethral meatus exposure present around 10% treatment failure.
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Affiliation(s)
- Tatiana C Marques
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Zampieri N, Corroppolo M, Camoglio FS, Giacomello L, Ottolenghi A. Phimosis: stretching methods with or without application of topical steroids? J Pediatr 2005; 147:705-6. [PMID: 16291369 DOI: 10.1016/j.jpeds.2005.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Revised: 05/17/2005] [Accepted: 07/14/2005] [Indexed: 11/21/2022]
Abstract
Phimosis has been defined as unretractable foreskin without adherences or a circular band of tight prepuce preventing full retraction. We suggested a new treatment protocol combining betamethasone with stretching exercises to reduce the number of patients requiring surgery for phimosis. Between January 2003 and September 2004, 247 boys aged 4 to 14 years (mean 7.6) were included in this consecutive, prospective, open study. Patients were treated with 0.05% betamethasone cream applied to the distal aspect of the prepuce twice daily for the first 15 days, then once daily for 15 more days. Preputial gymnastics started 1 week after topical application of betamethasone. Ninety-six percent of patients receiving 1 or more cycles of betamethasone showed complete resolution of phimosis. There was a significant difference (P < .001) in response rate between the study and control groups. Only 10 boys in the study group had no response to steroid and stretching. Treatment with topical steroids, combined with stretching exercises, is a suitable alternative to surgical correction (preputial plasty/circumcision).
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Affiliation(s)
- Nicola Zampieri
- Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona, Verona, Italy- Policlinico G.B.Rossi, piazzale Scuro n. 1-Verona.
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Bréaud J, Guys JM. Décalottage ou circoncision : quelle indication dans le phimosis ? Arch Pediatr 2005; 12:1424-32. [PMID: 15979860 DOI: 10.1016/j.arcped.2005.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Accepted: 02/14/2005] [Indexed: 01/12/2023]
Abstract
Phimosis remains a major question for mothers and induces a high number of consultations. However, large epidemiologic series have shown that congenital phimosis may disappear spontaneously in around 80% of cases with development and should'nt need any treatment before the age of five or six years old. Theses elements go against sociocultural habits which induce many circumcisions before the age of six. Corticoid treatment of phimosis seems to be very efficient to facilitate the disparition of phimosis. The aim of this literature review is to evaluate medical, socioeconomical and therapeutics aspects of phimosis. Based on these data, we recommend never to treat phimosis before the age of one year old, to wait as long as possible for spontaneous evolution of phimosis until the age of five years old, and, in case of non evolution of congenital phimosis or pathologic phimosis to use as first step treatment corticoid topics rather than surgical treatment.
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Affiliation(s)
- J Bréaud
- Service de chirurgie infantile, hôpital l'Archet-II, CHU de Nice, route de saint-Antoine-de-Ginestière, 06202 Nice cedex 03, France.
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Yang SSD, Tsai YC, Wu CC, Liu SP, Wang CC. HIGHLY POTENT AND MODERATELY POTENT TOPICAL STEROIDS ARE EFFECTIVE IN TREATING PHIMOSIS: A PROSPECTIVE RANDOMIZED STUDY. J Urol 2005; 173:1361-3. [PMID: 15758802 DOI: 10.1097/01.ju.0000156556.11235.3f] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We report a prospective randomized study comparing the effects of highly potent and moderately potent topical steroids in treating pediatric phimosis. MATERIALS AND METHODS A total of 70 boys 1 to 12 years old with phimosis were randomly assigned to receive topical application of either betamethasone valerate 0.06% (a highly potent steroid) or clobetasone butyrate 0.05% (a moderately potent steroid). Parents of the boys were instructed to retract the foreskin gently without causing pain, and to apply the topical steroids over the stenotic opening of the prepuce twice daily for 4 weeks, then for another 4 weeks if no improvement was achieved. Retractibility of the prepuce was graded from 0 to 5. Response to treatment was arbitrarily defined as improvement in the retractibility score of more than 2 points. RESULTS Mean treatment and followup periods were 4.3 and 19.1 weeks, respectively. The response rates in boys treated with betamethasone valerate and clobetasone butyrate were 81.3% and 77.4%, respectively (p = 0.63). Mean retractibility score decreased from 3.9 +/- 1.0 to 1.7 +/- 1.1, and 4.2 +/- 1.0 to 1.9 +/- 1.0 in the betamethasone and clobetasone groups, respectively. Both steroids were effective in all age groups. Pretreatment retractibility score did not affect treatment outcomes. No adverse effect was encountered. CONCLUSIONS Highly potent and moderately potent topical steroids are of comparable effectiveness in treating phimosis. A less potent steroid may be considered first to decrease the risk of the potential adverse effects.
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Leclair MD, Camby C, Battisti S, Renaud G, Plattner V, Heloury Y. Unstented Tubularized Incised Plate Urethroplasty Combined with Foreskin Reconstruction for Distal Hypospadias. Eur Urol 2004; 46:526-30. [PMID: 15363572 DOI: 10.1016/j.eururo.2004.04.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2004] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIM Urethral stent has recently been proven to be unnecessary for normal healing in an animal model of tubularized incised plate (TIP) urethroplasty. We report our experience with unstented TIP repair combined with foreskin reconstruction for distal hypospadias in children. PATIENTS AND METHODS We retrospectively reviewed the records of 162 children consecutively treated by TIP urethroplasty for a distal or mid-shaft hypospadias without urethral stent over a 6 years period. The mean age +/- SEM at surgery was 15.7 +/- 1.2 months. A foreskin reconstruction was performed with the hypospadias repair in 136 boys (84%). One hundred thirty one children (81%) underwent this surgery as an outpatient procedure. RESULTS With a mean follow-up of 12.4 +/- 1.0 months, urethrocutaneous fistula was observed in 9 children (5.6%), and meatal stenosis in 4 (2.5%). Postoperative urinary retention requiring suprapubic catheter insertion was observed in 4 cases (2.5%) without later complications. Cutaneous dehiscence of the reconstructed foreskin occurred in 6 children (4.4%) and phimosis in 13 (9.5%). CONCLUSIONS Absence of urethral stent after TIP urethroplasty for distal hypospadias repair does not seem to increase postoperative complication rate. Foreskin reconstruction in distal hypospadias surgery has an acceptable complication rate.
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Affiliation(s)
- Marc-David Leclair
- Department of Paediatric Urology, Service de Chirurgie Infantile, Hôpital Mère-Enfant, CHU de Nantes, 44093 Nantes Cedex 01, France.
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Alanis MC, Lucidi RS. Neonatal Circumcision: A Review of the World’s Oldest and Most Controversial Operation. Obstet Gynecol Surv 2004; 59:379-95. [PMID: 15097799 DOI: 10.1097/00006254-200405000-00026] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
UNLABELLED Untimely old, circumcision has elicited more controversy and war of words than any surgical procedure in history. Although previous claims of benefits like curing masturbation, gout, epilepsy, and even insanity were no doubt absurd, important research has shed light on real medical benefits of circumcision. In particular, the procedure has consistently shown to result in the decreased risk of debilitating and costly diseases such as HIV, cervical cancer, and infantile urinary tract infection. Because of advances in the understanding of the anatomy of the foreskin and pain conditioning in infants, prevailing attitudes have changed about anesthesia and analgesia during the procedure. This article objectively summarizes the bulk of significant medical literature over the last century to provide an accurate statement about what we know and what we do not know about neonatal circumcision, including its history, epidemiology, medical benefits, complications, contraindications, techniques, management for pain, and current controversies. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be able to describe the evolution of circumcision, to list the potential benefits of circumcision, to outline the various neonatal circumcision techniques, and to summarize the data on the use of analgesia for circumcision.
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Affiliation(s)
- Mark C Alanis
- Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina, USA.
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Villanueva A, Jiménez J, Eizaguirre I. [Phimosis]. An Pediatr (Barc) 2004; 60:487. [PMID: 15105012 DOI: 10.1016/s1695-4033(04)78316-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
As one of the most frequently performed operations circumcisions can entail not only typical but also rare complications with possibly fatal consequences. The following areas are of particular importance: legal aspects of the operation, indication for an operation, pre-operative information, post-operative surveillance and after-care. The amount of circumcisions carried out in different European countries vary widely. This shows a difference in indication assessment, which may suppose that a number of operations are not necessary.
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Affiliation(s)
- E Stark
- Urol. Abt., St. Antonius-Hospital Eschweiler, Germany
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