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Topical corticosteroids for phimosis in children: a network meta-analysis of randomized clinical trials

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Abstract

Background

Corticosteroids and hyaluronidase are trialed for treating phimosis in children. We carried out the present network meta-analysis to compare the therapeutic effect of these drugs.

Methods

Electronic databases were searched for appropriate randomized clinical trials. Odds ratio (OR) with 95% confidence intervals (95% CI) was used as the effect estimate. A random-effects model was used for generating the pooled estimates. Rankogram plot was used for ranking the drugs.

Main outcome measures

Proportions of patients with remission (partial/complete) and with complete remission.

Results

Mometasone (OR 6.53, 95% CI 2.85, 14.96), betamethasone/hyaluronidase (OR 12.1, 95% CI 4.27, 34.49), triamcinolone (OR 19.15, 95% CI 4.47, 81.96), dexamethasone (OR 21.38, 95% CI 5.71, 79.98), betamethasone (OR 23.02, 95% CI 6.92, 79.54), hydrocortisone (OR 23.2, 95% CI 5.91, 91.02) and methylprednisolone (OR 50.47, 95% CI 4.45, 572.72) were observed with significantly higher proportions of patients with remission (partial/complete) compared to placebo. Dexamethasone, triamcinolone, betamethasone, betamethasone/hyaluronidase, clobetasol, mometasone, and hydrocortisone were observed with significantly higher proportions of patients with complete remission compared to placebo. Beclomethasone was not observed to be superior to either placebo or other drugs. Rankogram plot revealed methylprednisolone followed by hydrocortisone had the maximum statistical probability of being ‘the best’ in the pool for remission and betamethasone followed by hydrocortisone for complete remission.

Conclusion

Topical methylprednisolone, hydrocortisone, and betamethasone were observed with better clinical resolution of phimosis compared to other corticosteroids. Very high potent corticosteroids like beclomethasone and clobetasol were not observed with superior benefits compared to other corticosteroids. Considering low-potency, hydrocortisone shall be preferred until further evidence emerges.

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Availability of data and material

The data are available from the individual studies that are freely present in the public domain.

Abbreviations

AMSTAR:

Assessing the methodological quality of systematic reviews

CI:

Confidence intervals

OR:

Odds ratio

PRISMA:

Preferred reporting items in systematic review and meta-analysis

SUCRA:

Surface area under cumulative ranking curve

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Authors and Affiliations

  1. Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain

    Kannan Sridharan

  2. Department of Dental Training, Ministry of Health, Manama, Kingdom of Bahrain

    Gowri Sivaramakrishnan

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  1. Kannan Sridharan
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  2. Gowri Sivaramakrishnan
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Contributions

KS-conceived the idea KS, GS–drafted the proposal, indulged in data collection KS-analysed the data and prepared the first draft of the manuscript KS, GS–involved in subsequent revisions of the manuscript.

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Correspondence to Kannan Sridharan.

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Sridharan, K., Sivaramakrishnan, G. Topical corticosteroids for phimosis in children: a network meta-analysis of randomized clinical trials. Pediatr Surg Int 37, 1117–1125 (2021). https://doi.org/10.1007/s00383-021-04906-1

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