Circumcision is traditionally performed for persistent phimosis in boys.
Although there continues to be a considerable debate over the merits of
circumcision, it is clear that preservation of the pediatric foreskin even
in the presence of phimosis is a viable option. Prepuce spontaneously
separates from the glans as the age increases and true phimosis is rare in
children(1). Prepuce develops and separates from the glans. As it takes
time to do so, normal physiological nonseparation is mistaken as phimosis
and referred for circumcision. Surgical intervention should be avoided for
nonseparation of prepuce. If an unretractable prepuce causes hygienic
problems, topical corticosteroid application may be an effective
alternative to circumcision. We conducted a study to evaluate the role of
long acting topical steroid, mometasone furoate in the topical treatment
of phimosis.
A total of 800 boys, 1 to 3 years of age with an
unretractable prepuce were treated in our clinic since 1998 with
mometasone furoate 0.1% which was applied to the tip of penis twice daily.
After treatment duration of 4 to 8 weeks, 87% of the patients achieved
complete or near complete retractability of the prepuce. These children
had type IV/ III retractible prepuce(2). Circumcision was carried out in
13% Type II and Type I with incomplete or no separation. No local or
systemic adverse effects were noted.
Spontaneous prepuce retraction occurs in 80% of boys up
to the age of two, whereas in the remaining, retraction is mostly achieved
later in the childhood. Attempts at retraction probably cause secondary
phimosis, due to tissue damage and scar formation, which may then require
operation. We located 13 studies on the effectiveness and the safety of
topical steroid application for phimosis, three of them were placebo
controlled. Various steroids have been tried with encouraging results.
Success rate is high when patient selection is appropriate and long acting
steroid is used.
The topical application of mometasone furoate 0.1% is a
highly efficacious, safe, and well-tolerated treatment of phimosis in this
large series of boys. Nevertheless, hygiene and preputial traction, when
appropriately performed, also seem to play an important role in the
disappearance of the phimotic ring (3,4).
References
1. Gairdner D. The fate of the foreskin. Br Med J 1949;
2: 1433-1437.
2. Kayaba H, Tamura H, Kitajima S, Fujiwara Y, Kato T,
Kato T. Analysis of shape and retractibility of the prepuce in 603
Japanese boys. J Urol 1996; 156:1813-1815.
3. Pileggi Fde O, Vicente YA. Phimotic ring topical
corticoid cream (0.1% mometasone furoate) treatment in children. J Pediatr
Surg 2007; 42: 1749-1752.
4. Esposito C, Centonze A, Alicchio F, Savanelli A,
Settimi A. Topical steroid application versus circumcision in
pediatric patients with phimosis: A prospective randomized placebo
controlled clinical trial. World J Urol 2008; 26:187-190.