title: Topical betamethasone and hyaluronidase in the treatment of phimosis in boys: a double-blind, randomized, placebo-controlled trial. Local steroid therapy as the first‐line treatment for boys with symptomatic phimosis – a long‐term prospective study Topical steroid application versus circumcision in pediatric patients with phimosis: a prospective randomized placebo controlled clinical trial Conservative treatment of phimosis with fluticasone proprionate 0.05%: a clinical study in 1185 boys. Highly potent and moderately potent topical steroids are effective in treating phimosis: a prospective randomized study. The conservative treatment of phimosis in boys. Topical triamcinolone for persistent phimosis. Topical hydrocortisone and physiotherapy for nonretractile physiologic phimosis in infants Topical clobetasol propionate compared with placebo in the treatment of unretractable foreskin. Topical steroid treatment of phimosis in boys. Phimosis: stretching methods with or without application of topical steroids? Psychological trauma of circumcision in the phallic period could be avoided by using topical steroids. An 18-month follow-up study after randomized treatment of phimosis in boys with topical steroid versus placebo
abstract: PURPOSE To compare the efficacy of three different formulations containing Betamethasone Valerate versus placebo in the topical treatment of phimosis . As a secondary goal , we compared the outcomes after 30 and 60 days of treatment . MATERIAL S AND METHODS Two hundred twenty boys aged 3 to 10 years old with clinical diagnosis of phimosis were enrolled . Patients were r and omized to one of the following groups : Group 1 : Betamethasone Valerate 0.2 % plus Hyaluronidase ; Group 2 : Betamethasone Valerate 0.2 % ; Group 3 : Betamethasone Valerate 0.1 % or Group 4 : placebo . Parents were instructed to apply the formula twice a day for 60 days and follow-up evaluations were scheduled at 30 , 60 and 240 days after the first consultation . Success was defined as complete and easy foreskin retraction . RESULTS One hundred ninety-five patients were included at our final analysis . Group 1 ( N = 54 ) , 2 ( N = 51 ) and 3 ( N = 52 ) had similar success and improvement rates , all treatment groups had higher success rates than placebo ( N = 38 ) . After 60 days of treatment , total and partial response rates for Groups 1 , 2 and 3 were 54.8 % and 40.1 % , respectively , while placebo had a success rate of 29 % . Success and improvement rates were significantly better in 60 days when compared to 30 days . CONCLUSIONS Betamethasone Valerate 0.1 % , 0.2 % and 0.2 % in combination with Hyaluronidase had equally higher results than placebo in the treatment of phimosis in boys from three to ten years-old . Patients initially with partial or no response can reach complete response after 60 days of treatment Aim : Phimosis is a common paediatric urological disorder and often necessitates circumcision . We prospect ively evaluated  local steroid therapy ( LST )  as the first choice therapy for such children 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 prospect i ve 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 r and om 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 m and atory OBJECTIVE Circumcision has been the traditional method of choice in the treatment of boys with phimosis . Recently , several published studies worldwide have focused their interest on more conservative approaches in management of this condition . These studies advocate the use of topical steroids in the phimotic foreskin . We aim ed to investigate the efficacy and safety of a medium potency corticosteroid in boys with different types of prepuce retractabilty . PATIENTS AND METHODS A prospect i ve study was performed involving boys referred to our hospital for possible phimosis between January 2004 and February 2008 . All were treated initially with fluticasone proprionate 0.05 % for a period of 4 - 8 weeks . Patients were reassessed after 6 months of follow up . RESULTS A total of 1185 boys with a diagnosis of phimosis were treated with fluticasone proprionate 0.05 % . Successful results were achieved in 1079 ( 91.1 % ) patients including boys with mild balanitis xerotica obliterans . No side effects were noticed . CONCLUSION Our results show that fluticasone proprionate 0.05 % , a mild potent corticosteroid , is effective and safe in the treatment of boys with different types of phimosis PURPOSE We report a prospect i ve r and omized study comparing the effects of highly potent and moderately potent topical steroids in treating pediatric phimosis . MATERIAL S AND METHODS A total of 70 boys 1 to 12 years old with phimosis were r and omly assigned to receive topical application of either betamethasone valerate 0.06 % ( a highly potent steroid ) or clobetasone butyrate 0.05 % ( a moderately potent steroid ) . Parents of the boys were instructed to retract the foreskin gently without causing pain , and to apply the topical steroids over the stenotic opening of the prepuce twice daily for 4 weeks , then for another 4 weeks if no improvement was achieved . Retractibility of the prepuce was grade d from 0 to 5 . Response to treatment was arbitrarily defined as improvement in the retractibility score of more than 2 points . RESULTS Mean treatment and followup periods were 4.3 and 19.1 weeks , respectively . The response rates in boys treated with betamethasone valerate and clobetasone butyrate were 81.3 % and 77.4 % , respectively ( p = 0.63 ) . Mean retractibility score decreased from 3.9 + /- 1.0 to 1.7 + /- 1.1 , and 4.2 + /- 1.0 to 1.9 + /- 1.0 in the betamethasone and clobetasone groups , respectively . Both steroids were effective in all age groups . Pretreatment retractibility score did not affect treatment outcomes . No adverse effect was encountered . CONCLUSIONS Highly potent and moderately potent topical steroids are of comparable effectiveness in treating phimosis . A less potent steroid may be considered first to decrease the risk of the potential adverse effects OBJECTIVE To further test the application of topical steroids in boys referred to a paediatric surgical practice with pathological , non-retractable foreskins diagnosed as phimosis . PATIENTS AND METHODS This prospect i ve study comprised two groups of 20 boys each ( mean age 4.1 years , range 3 - 6 ) diagnosed as having phimosis ; twice daily , a topical steroid ( 0.05 % betamethasone cream ) was applied on the narrowed preputial skin in the first group and a neutral cream ( Vaseline ) in the second ( control ) group . Patients were treated for 4 weeks and the retractability of the foreskin and any side-effects assessed . RESULTS Good retraction of the foreskin was achieved in 19 patients treated with betamethasone cream and the response was unsatisfactory in 16 patients from the control group ; these 16 boys and one 6-year-old boy treated with betamethasone were circumsized . There were no side-effects or problems after the application of either cream . CONCLUSION Treatment with 0.05 % betamethasone cream is a simple and safe method for the treatment of phimosis in boys older than 3 years . An early operation is necessary in cases of genuine phimosis when 1 month of treatment with topical steroids has failed . We strongly support the saying , " The fortunate foreskin of an infant boy will usually be left well alone by everyone but its owner ' PURPOSE Between 2 % and 5 % of uncircumcised boys have persistent or pathological phimosis . Traditional treatment is usually circumcision . Recently medical treatment with topical corticosteroids has become more popular . We evaluated the efficacy of the topical steroid triamcinolone compared to foreskin retraction with an emollient cream and verified the long-term success rate of these treatments . MATERIAL S AND METHODS We performed a double-blind , r and omized , placebo controlled study to compare 2-month twice daily treatment with emollient cream ( placebo group 1 ) vs 0.1 % triamcinolone ( experimental group 2 ) . Boys between ages 3 and 12 years with persistent or pathological phimosis were included in analysis . Study EXCLUSION criteria were previous treatment with topical corticosteroid , untreated balanitis and any known medical condition with immune system impairment . Patients were seen 2 , 4 and 12 months after treatment initiation . Success was defined as complete , easy foreskin retraction at 4 and 12 months . Statistical analysis was done using Fisher 's exact test . RESULTS We enrolled 63 patients , of whom 43 completed the study . Despite multiple attempts 20 patients had incomplete followup and were excluded from study . Placebo group 1 included 25 patients and triamcinolone group 2 included 21 . In group 1 the success rate was significantly lower than in group 2 ( 9 patients or 39 % vs 16 or 76 % , p = 0.0086 ) . At 2 months 5 and 16 nonresponders in groups 2 and 1 , respectively , were treated in nonblinded fashion with topical triamcinolone . In this subgroup 1 of 3 group 2 patients and 6 of 13 in group 1 achieved complete , easy retraction . Two and 1 patients were lost to followup in groups 1 and 2 , respectively . Circumcision was required in only 5 patients ( 11.6 % ) , including 4 ( 17.4 % ) initially in group 1 . No complications were noted in either group . CONCLUSIONS Triamcinolone is a highly effective and safe short-term treatment for persistent physiological or pathological phimosis . However , at long-term followup recurrence is frequent and not rare with triamcinolone and it may require re-treatment or circumcision The effect of hydrocortisone ( HC ) , the steroid of lowest potency , and physiotherapy ( PT ) on non-retractile physiologic phimosis ( PP ) and the reduction of subsequent recurrent UTI was evaluated in male infants with UTI . Seventy-eight male infants with febrile UTI and nonretractile PP were prospect ively r and omized into HC ( Plancol , n=39 ) and control ( Vaseline , n=39 ) groups . Topical application of HC as a thin film around the preputial margin twice a day for four weeks with PT was instructed . The response rate in the HC group was 89.7 % ( 35/39 ) , which was significantly higher than the rate ( 20.5 % ; 8/39 ) in the control group ( P<0.05 ) . In the HC group , the response rate was much higher ( 96.1 % ) in the subgroup with PT than in the group without PT . Most of the response ( 88.5 % ) was observed within two weeks . During the following year , the recurrent rate of UTI was 7.1 % ( 2/28 ) in the infants with retractile prepuces , which was significantly less than than the rate ( 29.6 % ; 8/27 ) in infants with nonretractile prepuces ( P<0.05 ) . In conclusion , topical HC and PT for 2–4 weeks proved to be a simple , safe and effective treatment for nonretractile PP in infants with UTI , and this procedure was beneficial in reducing recurrent UTI OBJECTIVE To assess whether it is the steroid alone or the gentle physical retraction combined with ointment that is responsible for the excellent results observed with topical steroid treatment of unretractable foreskin . DESIGN Prospect i ve , r and omised , double-blind study . SETTING University hospital , Sweden . SUBJECTS 30 Boys r and omised to be treated with clobetasol propionate ( n = 15 ) or placebo ( n = 15 ) . INTERVENTIONS The boys were examined 1 , 2 and 6 months , respectively , after treatment . MAIN OUTCOME MEASURES Comparison between the effects of clobetasol propionate and placebo .  RESULTS Two patients in the steroid group and one in the placebo group withdrew from the study . 10 Boys in the steroid group showed an improvement within 2 months . The remaining 3 boys had no effect and were circumcised . Histopathological examination showed lichen sclerosus et atrophicus . Seven boys in the placebo group improved . The 7 non-responders were prescribed  clobetasol propionate ointment  , and all 7 improved . CONCLUSION 17 of 27 boys referred with " phimosis " were successfully treated with an ointment and gentle traction . When clobetasol propionate was given the non-responders success rate was increased to 24/27 ( 89 % ) PURPOSE We evaluate whether steroid application alone or retraction and hygiene are responsible for successful results in boys treated with topical steroids for phimosis . MATERIAL S AND METHODS A prospect i ve study was performed , which included a control group of 42 patients with phimosis seen at our outpatient department from January to June 1997 . During that time we trained the parent to retract and clean the foreskin only . From July 1997 to June 1998 topical steroid cream was prescribed in addition to retraction and hygiene in 276 boys with phimosis . All cases were divided into 3 subgroups of asymptomatic , symptomatic and buried penis . RESULTS The response rate was greater than 95 % in patients who received topical steroid treatment in addition to improved hygiene . Only 13 boys ( less than 5 % ) had no response to steroid treatment . Of the control patients 23 ( 55 % ) had no response to gentle retraction and personal hygiene . There was a significant difference ( p<0.001 ) in response rate between the study and control groups . However , the subgroup with a buried penis responded poorly to  steroid , retraction and hygiene treatment .  There was significant difference ( p<0.001 ) in response rate between the buried penis and other steroid groups but no significant difference ( p>0.05 ) in the control group . CONCLUSIONS Phimosis is a physiological condition in neonates due to natural adhesion between the foreskin and the glans . Chronic infection due to poor hygiene is responsible for most cases of childhood phimosis . Circumcision is the traditional treatment of choice for phimosis or unretractable foreskin , although it is not always desired by parents or surgeons . Topical steroid cream is an easy , safe and nonsurgical alternative for phimosis . However , boys with a buried penis are not good c and i date s for steroid treatment Phimosis has been defined as unretractable foreskin without adherences or a circular b and of tight prepuce preventing full retraction . We suggested a new treatment protocol combining betamethasone with stretching exercises to reduce the number of patients requiring surgery for phimosis . Between January 2003 and September 2004 , 247 boys aged 4 to 14 years ( mean 7.6 ) were included in this consecutive , prospect i ve , open study . Patients were treated with 0.05 % betamethasone cream applied to the distal aspect of the prepuce twice daily for the first 15 days , then once daily for 15 more days . Preputial gymnastics started 1 week after topical application of betamethasone . Ninety-six percent of patients receiving 1 or more cycles of betamethasone showed complete resolution of phimosis . There was a significant difference ( P < .001 ) in response rate between the study and control groups . Only 10 boys in the study group had no response to steroid and stretching . Treatment with topical steroids , combined with stretching exercises , is a suitable alternative to surgical correction ( preputial plasty/circumcision ) OBJECTIVE The objective of our study was to assess the efficacy of topical steroids in the treatment of phimosis and evaluate patients using the Diagnostic and Statistical Manual-III-Revised ( DSM-III-R ) test  with the aim of eliminating castration anxiety of circumcision in the phallic period . METHODS One hundred and forty-nine children with phimosis who required circumcision were included the study . The average age of the children was 4.47 years . All children underwent the DSM-III-R test and their parents were question ed . Patients were separated r and omly into three groups . Group I comprised 51 children who would undergo circumcision ; group II comprised 50 children who would be treated with a topical corticosteroid ( 0.05 % bethamethasone cream ) twice daily for 1 month ; and group III comprised 48 children who would be treated with a topical placebo cream . On the 5th day of treatment , parents were told to retract the prepuce and were given hygiene routine instructions . Patients were seen immediately after treatment and again 2 months later . RESULTS In group II , 16 of the 50 children had non-retractable prepuce . Forty-two cases of phimosis were corrected after treatment . Eight patients received further monthly treatment and five benefited from the second course of treatment . In group III , 17 of the 48 patients had non-retractable prepuce and four had satisfactory results . Forty-four patients received placebo treatment for another month and eventually , 40 children underwent circumcision in this group . DSM-III-R test results showed a significant shift to anxiety in the circumcision group . The were no significant differences in the other groups . CONCLUSION Topical steroids for the treatment of phimosis is a highly effective treatment alternative to surgery . It avoids or delays circumcision and can be practised during the phallic period to decrease castration anxiety . The treatment is suitable for patients from any religious or cultural background Objective To evaluate the treatment of  phimosis  using topical steroid . Material and methods This was a follow-up study after a prospect i ve , r and omized , double-blind study . A total of 137 boys with phimosis were r and omly assigned to either betamethasone treatment or placebo for 4 weeks , with application of the cream twice daily . Non-responders to treatment were offered steroid treatment for a further 4 weeks . All patients were invited to a follow-up examination after 18 months . Results The mean pre-treatment phimosis grade s in the steroid and control groups were 5.08±0.66 and 4.97±0.70 , respectively . At the 4-week follow-up , 49 boys ( 74 % ) in the steroid group were cured , compared to only 31 ( 44 % ) in the control group . Fourteen boys were circumcised after another 4 weeks of treatment ; 43 of the remaining 57 boys ( 17 in the steroid group ; 40 in the control group ) had been cured . After a total of 92 boys took part in the 18-month follow-up study : 79 had been cured and 13 had suffered a relapse . Twenty-six patients did not took part in the follow-up investigation . No side-effects were noted . Conclusions When treatment is necessary for phimosis , we recommend application of topical steroid as first-line treatment because surgery can then be avoided in 85 % of cases . This first r and omized , double-blind , follow-up study shows that the treatment effect persists for at least 18 months
target: Conclusions Compared to the placebo or manual reduction method , the topical steroid therapy is more effective in the treatment of phimosis in children .
  Although there is still controversy in the different type and dosage of steroid , this could be used against phimosis before circumcision
background: Abstract Purpose We evaluated a systematic review on the therapeutic efficacy of topical steroids in children with phimosis to provide data for the clinical options of pediatric phimosis .