Topical corticosteroids offer an effective alternative for treating phimosis in boys .
Although sub optimal reporting among the included studies meant that the size of the effect remains uncertain , corticosteroids appear to be a safe , less invasive first-line treatment option before undertaking surgery to correct phimosis in boys
BACKGROUND Until recently , phimosis has been treated surgically by circumcision or prepuceplasty ; however , recent reports of non-invasive treatment using topical corticosteroids applied for four to eight weeks have been favourable .
The efficacy and safety of topical corticosteroids for treating phimosis in boys has not been previously systematic ally review ed .
OBJECTIVES We aim ed 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 .
Topical triamcinolone for persistent phimosis.
PURPOSE Between 2 % and 5 % of uncircumcised boys have persistent or pathological phimosis . Traditional treatment is usually circumcision . Recently medical treatment with topical corticosteroids has become more popular . We evaluated the efficacy of the topical steroid triamcinolone compared to foreskin retraction with an emollient cream and verified the long-term success rate of these treatments . MATERIAL S AND METHODS We performed a double-blind , r and omized , placebo controlled study to compare 2-month twice daily treatment with emollient cream ( placebo group 1 ) vs 0.1 % triamcinolone ( experimental group 2 ) . Boys between ages 3 and 12 years with persistent or pathological phimosis were included in analysis . Study EXCLUSION criteria were previous treatment with topical corticosteroid , untreated balanitis and any known medical condition with immune system impairment . Patients were seen 2 , 4 and 12 months after treatment initiation . Success was defined as complete , easy foreskin retraction at 4 and 12 months . Statistical analysis was done using Fisher 's exact test . RESULTS We enrolled 63 patients , of whom 43 completed the study . Despite multiple attempts 20 patients had incomplete followup and were excluded from study . Placebo group 1 included 25 patients and triamcinolone group 2 included 21 . In group 1 the success rate was significantly lower than in group 2 ( 9 patients or 39 % vs 16 or 76 % , p = 0.0086 ) . At 2 months 5 and 16 nonresponders in groups 2 and 1 , respectively , were treated in nonblinded fashion with topical triamcinolone . In this subgroup 1 of 3 group 2 patients and 6 of 13 in group 1 achieved complete , easy retraction . Two and 1 patients were lost to followup in groups 1 and 2 , respectively . Circumcision was required in only 5 patients ( 11.6 % ) , including 4 ( 17.4 % ) initially in group 1 . No complications were noted in either group . CONCLUSIONS Triamcinolone is a highly effective and safe short-term treatment for persistent physiological or pathological phimosis . However , at long-term followup recurrence is frequent and not rare with triamcinolone and it may require re-treatment or circumcision
Topical corticosteroids offer an effective alternative for treating phimosis in boys .
Although sub optimal reporting among the included studies meant that the size of the effect remains uncertain , corticosteroids appear to be a safe , less invasive first-line treatment option before undertaking surgery to correct phimosis in boys
BACKGROUND Until recently , phimosis has been treated surgically by circumcision or prepuceplasty ; however , recent reports of non-invasive treatment using topical corticosteroids applied for four to eight weeks have been favourable .
The efficacy and safety of topical corticosteroids for treating phimosis in boys has not been previously systematic ally review ed .
OBJECTIVES We aim ed 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 .