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Topical steroid application versus circumcision in pediatric patients with phimosis: a prospective randomized placebo controlled clinical trial

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Abstract

Objectives

Topical steroids have been advocated as an effective alternative treatment to circumcision in boys with phimosis. We evaluated the effectiveness of topical steroid therapy compared to a placebo neutral cream in 240 patients with phimosis.

Methods

A prospective study was carried out over a 24-months period, on an out-patient basis on two groups of patients with phimosis. One-hundred twenty patients applied a steroid cream twice a day for 4 weeks, and another group of 120 pts used a placebo cream twice a day for 4 weeks. Patients were assigned to either group by a computer-generated random choice.

Results

All patients in our series completed the two treatment periods without interruption. At a median follow-up of 20 months (6–30 months) therapeutic success was obtained in 43.75% (99/240) of cases, independently of the protocol. In particular, therapeutic success was obtained in 65.8% (79/120) of cases in the steroids group and in 16.6% (20/120) of cases in the placebo group, the difference being statistically significant (P < 0.0001, Mann–Withney test).

Conclusion

Our study shows that topical steroids represent a good alternative to surgery in case of phimosis. Steroid therapy using monometasone furoate 0.1% in our series gave better results that placebo with an overall efficacy of 65.8%. In patients where a phimotic ring persist after steroid therapy, circumcision is mandatory.

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References

  1. Ashfield JE, Nickel KR, Siemens DR, MacNeily AE, Nickel JC (2003) Treatment of phimosis with topical steroids in 194 children. J Urol 169:1106–1110

    Article  PubMed  CAS  Google Scholar 

  2. Elmore JM, Baker LA, Snodgrass WT (2002) Topical steroid therapy as an alternative to circumcision for phimosis younger than 3 years. J Urol 168:1746–1750

    Article  PubMed  CAS  Google Scholar 

  3. Kayaba H, Tamura H, Kitajima S, Fujiwara Y, Kato T, Kato T (1996) Analysis of shape and retractability of the prepuce in 603 Japanese boys. J Urol 156:1813–1815

    Article  PubMed  CAS  Google Scholar 

  4. Atilla MK, Dundaro R, Odabas O, Ozturk H, Akin R, Gokcay E (1997) A nonsurgical approach to the treatment of phimosis: local nonsteroidal anti-inflammatory ointment application. J Urol 158:196–201

    Article  PubMed  CAS  Google Scholar 

  5. Golubovic Z, Milanovic D, Vukadinovic V, Rakic I, Perovic S (1996) The conservative treatment of phimosis in boys. Br J Urol 78:786–790

    PubMed  CAS  Google Scholar 

  6. Kikiros CS, Beasley SW, Woodward AA (1993) The response of phimosis to local steroid application. Pediatr Surg Int 8:329–332

    Article  Google Scholar 

  7. Chu CC, Chen KC, Diau GY (1999) Topical steroid treatment of phimosis in boys. J Urol 162:861–864

    Article  PubMed  CAS  Google Scholar 

  8. Monsour MA, Rabinovitch HH, Dean GE (1999) Medical management of phimosis in children: our experience with topical steroids. J Urol 162:1162–1167

    Article  PubMed  CAS  Google Scholar 

  9. Orsola A, Caffaratti J, Garat JM (2000) Conservative treatment of phimosis in children using a topical steroid. Urology 56:307–310

    Article  PubMed  CAS  Google Scholar 

  10. Kragballe K (1989) Topical corticosteroids: mechanisms of action. Acta Derm Venereol 151:7–10

    CAS  Google Scholar 

  11. Ng WT, Fan N, Wong CK, Leung SL, Yuen KS, Sze YS (2001) Treatment of childhood phimosis with a moderately potent topical steroid. ANZ J Surg 71:541–543

    Article  PubMed  CAS  Google Scholar 

  12. Wright JE (1994) The treatment of childhood phimosis with topical steroid. Aust N Z J Surg 64:327–330

    Article  PubMed  CAS  Google Scholar 

  13. To T, Agha M, Dick PT, Feldman W (1998) Cohort study on circumcision of newborn boys and subsequent risk of urinarytract infection. Lancet 352:1813–1817

    Article  PubMed  CAS  Google Scholar 

  14. Cuckow PM (1998) Circumcision. In: Stringer MD, Oldham KT, Mouriquand P, Howard ER (eds) Pediatric surgery and urology: long term outcomes. W. B. Saunders Co Ltd, London, pp 616–620

    Google Scholar 

  15. Krafchik BR (1995) The use of topical steroids in children. Semin Dermatol 14:70–74

    Article  PubMed  CAS  Google Scholar 

  16. MacKie RM (2004) Drug eruptions. In: Lay G, Ragon FG (eds) Clinical dermatology, Oxford University Press, New York, pp 300–310

    Google Scholar 

  17. Perry RJ, Findlay CA, Donaldson MD (2002) Cushing’s syndrome, growth impairment, and occult adrenal suppression associated with intranasal steroids. Arch Dis Child 87:45–49

    Article  PubMed  CAS  Google Scholar 

  18. Zheng PS, Lavker RM, Lehmann P, Kligman AM (1984) Morphologic investigations on the rebound phenomenon after corticosteroid-induced atrophy in human skin. J Invest Dermatol 82:345–347

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Experimental and Clinical Medicine, Chair of Pediatric Surgery, Magna Graecia University, Campus S.Venuta, Viale Europa 11, 88100, Catanzaro, Italy

    Ciro Esposito & Antonella Centonze

  2. Department of Pediatrics, Federico II University, Via Pansini 5, 80131, Naples, Italy

    Francesca Alicchio, Antonio Savanelli & Alessandro Settimi

  3. Via Bernini 58, 80129, Naples, Italy

    Ciro Esposito

Authors
  1. Ciro Esposito
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  2. Antonella Centonze
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  3. Francesca Alicchio
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  4. Antonio Savanelli
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  5. Alessandro Settimi
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Correspondence to Ciro Esposito.

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Esposito, C., Centonze, A., Alicchio, F. et al. Topical steroid application versus circumcision in pediatric patients with phimosis: a prospective randomized placebo controlled clinical trial. World J Urol 26, 187–190 (2008). https://doi.org/10.1007/s00345-007-0231-2

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  • DOI: https://doi.org/10.1007/s00345-007-0231-2

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