Treatment of phimosis with topical steroids in 194 children.
OBJECTIVE
Topical steroids have been advocated as an effective economical alternative to circumcision in boys with phimosis. We evaluated the effectiveness of topical steroid therapy as primary treatment in 194 patients with phimosis.


METHODS
Between January 1996 and November 2000, 228 boys 16 years old or younger were referred for consideration of circumcision. When intervention was determined to be necessary, a 6-week course of topical steroids was used as primary treatment. Efficacy of treatment was evaluated at 3 months from initiation of therapy.


RESULTS
Of the 228 patients 15 had such a mild degree of phimosis that no intervention was believed to be necessary, 19 were scheduled directly for circumcision due to cosmetic reasons, parent wishes, or severe phimosis with associated voiding problems and the remaining 194 received topical steroids as primary treatment. Of these 194 patients 25 had coexisting balanitis and 4 had a history of urinary tract infection. Conservative treatment was successful in 87%, 88% and 75% of patients with phimosis alone, coexisting balanitis and history of urinary tract infection, respectively. Overall, circumcision was avoided in 87% of patients treated with topical steroids.


CONCLUSIONS
Topical steroids are becoming the standard conservative measure for treating phimosis. Our study supports this trend, with an overall efficacy of 87%.
Ashfield
James E
JE
Department of Urology, Queen's University and Kingston General Hospital, Ontario, Canada.
Nickel
Kyle R
KR
Siemens
D Robert
DR
MacNeily
Andrew E
AE
Nickel
J Curtis
JC
D000287:Administration, Topical; D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001623:Betamethasone / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male; D005938:Glucocorticoids; D006801:Humans; D007223:Infant; D008297:Male; D009824:Ointments; D010688:Phimosis / Q000150:complications / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D009824:Ointments; D001623:Betamethasone