Medical Management of Phimosis in Children: Our Experience With Topical Steroids

Monsour, Mark A.; Rabinovitch, Hyman H.; Dean, Gregory

doi:10.1016/s0022-5347(01)68112-6

Cited by 105 publications

(60 citation statements)

References 12 publications

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“…Although in the last decades many authors have advocated the use of topical steroids as an alternative treatment of phimosis (1)(2)(3), with success rate ranging from 67 to 90% (4,5), circumcision is still the "gold standard" treatment for phimosis, and although not always performed for …”

Section: Introductionmentioning

confidence: 99%

A prospective evaluation of plastibell® circumcision in older children

et al. 2013

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Introduction and Objective:Circumcision is one of the oldest surgical procedures and one of the most frequently performed worldwide. It can be done by many different techniques. This prospective series presents the results of Plastibell® circumcision in children older than 2 years of age, evaluating surgical duration, immediate and late complications, time for plastic device separation and factors associated with it. Materials and Methods: We prospectively analyzed 119 children submitted to Plastic Device Circumcision with Plastibell® by only one surgeon from December 2009 to June 2011. In all cases the surgery was done under general anesthesia associated with dorsal penile nerve block. Before surgery length of the penis and latero-lateral diameter of the glans were measured. Surgical duration, time of Plastibell® separation and use of analgesic medication in the post-operative period were evaluated. Patients were followed on days 15, 45, 90 and 120 after surgery. Results: Age at surgery varied from 2 to 12.5 (5.9 ± 2.9) years old. Mean surgical time was 3.7 ± 2.0 minutes (1.9 to 9 minutes). Time for plastic device separation ranged from 6 to 26 days (mean: 16 ± 4.2 days), being 14.8 days for children younger than 5 years of age and 17.4 days for those older than 5 years of age (p < 0.0001). The diameter of the Plastibell® does not interfered in separations time (p = 0,484). Late complications occurred in 32 (26.8%) subjects, being the great majority of low clinical significance, especially prepucial adherences, edema of the mucosa and discrete hypertrophy of the scar, all resolving with clinical treatment. One patient still using diaper had meatus stenosis and in one case the Plastibell® device stayed between the glans and the prepuce and needed to be removed manually. Conclusions: Circumcision using a plastic device is a safe, quick and an easy technique with low complications, that when occur are of low clinical importance and of easy resolution. The mean time for the device to fall is shorter in children under 6 years of age and it is not influenced by the diameter of the device.

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Section: Introductionmentioning

confidence: 99%

A prospective evaluation of plastibell® circumcision in older children

et al. 2013

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“…Various studies using topical steroid creams for conservative treatment of phimosis have yielded excellent results with 65% to 95% efficacy rate 6 .…”

Section: Discussionmentioning

confidence: 99%

Phimosis: Nonsurgical Versus Surgical Management

Kumar¹

2017

jmscr

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“…The effects of topical corticosteroids, which have anti-inflammatory and immunosuppressive properties, on the metabolism of arachidonic acid and inhibition of interleukin-1 synthesis have been well established. Topical corticosteroids can have an antiproliferative effect on the dermal matrix, decreasing skin thickness and obliterating the stratum corneum (11,12).…”

Section: Commentsmentioning

confidence: 99%

To circ or not to circ: clinical and pharmacoeconomic outcomes of a prospective trial of topical steroid versus primary circumcision

et al. 2010

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Purpose: To compare the efficacy and costs of circumcision versus topical treatment using a prospective pharmacoeconomic protocol. Materials and Methods:We treated 59 patients (3-10 years of age) randomized into two groups: 29 underwent an 8-week course of topical treatment with 0.2% betamethasone-hyaluronidase cream twice a day; and 30 underwent circumcision. Topical treatment success was defined as complete exposure of the glans. In cases of treatment failure, circumcision was performed and its cost imputed to that of the initial treatment. The pharmacoeconomic aspects were defined according to the Brazilian National Public Health System database and the Brazilian Community Pharmacies Index. Results: The two groups were statistically similar for all clinical parameters evaluated. Topical treatment resulted in complete exposure of the glans in 52% of the patients. Topical treatment was associated with preputial pain and hyperemia. However, treatment suspension was unnecessary. Minor complications were observed in 16.6% of the surgical group patients. The mean cost per patient was US$ 53.70 and US$ 125.20, respectively, for topical steroid treatment (including the costs related to treatment failure) and circumcision. The total costs were US$ 2,825.32 and US$ 3,885.73 for topical treatment and circumcision, respectively. Conclusions: Topical treatment of phimosis can reduce costs by 27.3% in comparison with circumcision. Therefore, topical treatment of phimosis should be considered prior to the decision to perform surgery.

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Medical Management of Phimosis in Children: Our Experience With Topical Steroids

Cited by 105 publications

References 12 publications

A prospective evaluation of plastibell® circumcision in older children

A prospective evaluation of plastibell® circumcision in older children

Phimosis: Nonsurgical Versus Surgical Management

To circ or not to circ: clinical and pharmacoeconomic outcomes of a prospective trial of topical steroid versus primary circumcision

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