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87% success with betamethasone only - Study results

Written by Ivan at 19 May 2003 22:01:21:

I found this abstract posted on AJ's Circ Message Board. I thought I would share it here, since I suspect not a lot of the regulars here lurk over there (but who knows?) Anyway, though the number of subjects is fairly small, such a strong trend is unlikely to be a matter of chance. It is a shame there wasn't a subgroup which was given stretching exercises as well. It is also disturbing that those who had not had 'adequate' resolution in twelve weeks were just amputated. Still, if 87% success is achieved without stretching exercises (other than, of course, what comes naturally), imagine how much better a combined approach would do.

"From
The Journal of Urology
March 2003 (Volume 169, Number 3)

Treatment of Phimosis With Topical Steroids in 194 Children
Ashfield JE, Nickel KR, Siemens DR, MacNeily AE, Nickel JC
The Journal of Urology. 2003;169(3):1106-1108

Although neonatal circumcision has been a standard practice in North America for many years, the incidence has been declining over the past decade. This change has created a new set of problems for primary healthcare givers and urologists who must treat foreskin problems associated with the uncircumcised penis. The traditional approach for managing phimosis and other associated problems has been circumcision under general anesthesia. This procedure has become less acceptable, as the same population that has elected to not circumcise their infants have similar objections to childhood circumcision for "minor" or transient foreskin problems.
This report examines the success of topical steroid treatment in 194 patients that were referred for circumcision because of persistent phimosis, balanitis, urinary tract infection, or for cosmetic reasons. Betamethasone ointment (0.1%) was applied to the foreskin twice a day for up to 6 weeks. No adverse reactions to the steroid cream were cited. After 3 months follow-up, the degree of phimosis was either insignificant or had resolved completely in 87%, and only 13% of the patients eventually required circumcision. Prior balanitis or urinary tract infection did not affect the outcome of the steroid therapy.
This report is another study that demonstrates the success of topical steroid therapy in an effort to avoid circumcision under anesthesia in older children. This article is an important contribution, as it is a report from a North American institution, where the threshold to proceed to circumcision has historically been lower than other countries, where the parent's desire to avoid late circumcision could potentially overstate the outcome or benefits of the topical steroid therapy. This therapy could also be applied to other foreskin problems such as persistent penile adhesions with similar expected results."


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