Elsevier

The Journal of Pediatrics

Volume 147, Issue 5, November 2005, Pages 705-706
The Journal of Pediatrics

Clinical and Laboratory Observation
Phimosis: Stretching Methods with or without Application of Topical Steroids?

https://doi.org/10.1016/j.jpeds.2005.07.017Get rights and content

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).

Section snippets

Methods

Between January 2003 and September 2004, 247 boys (4 to 14 years, mean 7.6) were included, after parental consent, in this consecutive and prospective open study on patients referred for surgical treatment of phimosis. Phimosis was graded according to the following 3-grade scale: Grade 1: The foreskin is fully unretractable, with the penis either flaccid or erect. Grade 2: There is partial or total exposure of the glans with a lacerated foreskin. Grade 3: There is a phimotic ring, unnoticeable

Results

Two hundred forty-seven patients adhered to our protocol (52 grade 1, 77 grade 2, and 118 grade 3). At 10 days after the end of the treatment cycle, 191(77.3%) patients reported complete resolution of phimosis with only one cycle; 56 (22.7%) patients needed a second treatment cycle, and 24 of these patients were invited to start a third cycle. Surgery was performed in only 10 patients (4%): 4 circumcisions and 6 preputial plasty.

The success rate in each group is shown in the Table as a function

Discussion

There are 2 possible mechanisms by which steroid cream may help resolve phimosis. First, there is an anti-inflammatory and immunosuppressive effect. Corticosteroids not only inhibit the early phenomenon of inflammation (edema, fibrin deposition, capillary dilation, migration of leukocytes into the inflamed area and phagocytic activity) but also its later manifestations (proliferation of capillaries and fibroblasts, depletion of collagen and cicatrization).

A second effect is skin thinning.

References (15)

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