title: Structural analysis of the phimotic prepuce in patients with failed topical treatment compared with untreated phimosis.
abstract: OBJECTIVE
  To evaluate histological alterations in prepuce of patients with phimosis submitted to topic treatment with betamethasone in association with hyaluronidase.
  
  
  METHODS
  We studied sixty patients (mean age 4.5), presenting true phimosis and treated with a topical treatment with betamethasone cream (0.2%) + hyaluronidase. The parents of seven of these patients opted for circumcision (control group). The other fifty-three patients were submitted to clinical treatment. The samples were stained with Weigert's resorcin-fuchsin (analysis of the elastic fibers) and Picro-Sirius Red, for analysis of the collagen. The volumetric density of the elastic fibers was determined by stereological methods.
  
  
  RESULTS
  Only eight (15 %) of the fifty-three patients submitted to topical treatment presented failure, being indicated for circumcision (histological analysis). We observed an increase of the collagen type III of the patients submitted to topical treatment. The quantification showed a reduction of the volumetric density of the prepuce's elastic fibers of the patients submitted to the cream treatment, when compared to the control group (p = 0.056). The volumetric density of the elastic fibers of the prepuce at the group not submitted to topical treatment showed an average of 14.60% (11.06 to 21.64%); in the group submitted to the cream treatment, the volumetric density of the elastic fibers of the prepuce showed an average of 10.34% (3.45 to 17.9%).
  
  
  CONCLUSIONS
  The topical treatment of phimosis with betamethasone 0.2 % + hyaluronidase had a success rate of 85 %. Patients with failure of the topical treatment with steroid had histological alterations in the prepuce.
authors.affiliation: Urogenital Research Unit, State University of Rio de Janeiro, Rua Professor Gabizo 104 / 201, Rio de Janeiro, RJ, Brazil. lufavorito@yahoo.com.br
authors.forename: Luciano Alves
authors.initials: LA
authors.lastname: Favorito
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Balassiano
authors.forename: João Pedro
authors.initials: JP
authors.lastname: Rosado
authors.forename: Luiz Eduardo M
authors.initials: LE
authors.lastname: Cardoso
authors.forename: Waldemar Silva
authors.initials: WS
authors.lastname: Costa
authors.forename: Francisco José Barcellos
authors.initials: FJ
authors.lastname: Sampaio
mesh_terms: D000287:Administration, Topical; D001623:Betamethasone / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004547:Elastic Tissue / Q000187:drug effects / Q000473:pathology; D052816:Foreskin / Q000187:drug effects / Q000473:pathology*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000627:therapeutic use*; D008297:Male; D010688:Phimosis / Q000188:drug therapy* / Q000473:pathology*; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D005938:Glucocorticoids; D001623:Betamethasone; D006821:Hyaluronoglucosaminidase