Conservative treatment of childhood phimosis with topical conjugated equine estrogen ointment

Abstract

Purpose: To assess the application of topical conjugated equine estrogen for the treatment of boys with phimosis. Methods: Fifteen boys with phimosis were included in the study. Conjugated equine estrogen (Premarin®) 0.1% ointment was applied on the prepuce once daily. The treatment was continued until the prepuce was fully retractable. The patient was examined each second week up to a maximum treatment of 8 weeks. Retractability and the appearance of the foreskin were graded before and after treatment.Results: Thirteen of 15 boys (87%) referred with phimosis were successfully treated with conjugated equine estrogen ointment. An adverse effect of gynecomastia was seen in one boy (7%). Conclusion: Conjugated equine estrogen ointment application for phimosis may be an alternative to surgery.

A Conservative Treatment of Phimosis in Boys

“…In these reports no side effects had been noted. Estrogen cream has also been applied to treat phimosis in boys, two studies reporting success rates of 87 and 93%, respectively [14, 15]. The adverse effect of gynecomastia was seen in 1 boy in each of these studies.…”

“…Continuation of the treatment is recommended if the treatment fails after one or two courses and in cases of recurrent phimosis, thereby reducing the need for circumcision [5, 9, 10, 11, 12, 14]. However, prolonged treatment with estrogen cream is undesirable because of the risk of side effects such as gynecomastia, testicular atrophy and skin pigmentation.…”

“…To avoid these complications and the discomfort after surgery, a more conservative approach to phimosis has been advocated in several recent studies which support the use of topical creams containing estrogen, steroids or nonsteroidal anti–inflammatory agents applied to the prepuce. Success rates from 67 to 95% have been reported [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. We present our experience with topical 0.05% clobetasol propionate cream for phimosis in boys.…”

Análise clínica e estudo anatomopatológico do prepúcio de pacientes submetidos à postectomia

“…4,5 Recentemente, o tratamento cirúrgico para fimose vem sendo substituído pelo uso de substâncias tópicas. Alguns estudos [6][7][8][9] mostraram taxa de cura entre 67 e 95%, com o uso de esteróides tópicos de média e alta potênica (clobetasol ou betametasona 0,05%). Nesses estudos, a não-realização da análise anatomopatológica dos prepúcios tratados impede o conhecimento sobre a incidência real da causa de fimose.…”

Estrogen enhances wound healing in the penis of rats

“…Furthermore, increased immunoreactivity of VEGF, which has been shown to enhance wound healing in other tissues, was observed in estrogentreated rats more than in vehicle only-treated rats (17). Indeed, there is a significant interest in treating penile skin disorders, such as infantile phimosis, using estrogen (13,22). However, there is need to elucidate the exact mechanisms underlying the estrogenic effects in penile wound healing, e.g., the specific ER subtype involved and the type of mediators likely to interact with estrogen, in order to exnot as intense as in 17β-estradiol-treated rats (Fig.…”