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PubMed1998

[A ventral slit of the prepuce in phimosis].

The appearance of the penis after circumcision is frequently not appreciated favourably by the patients nor their parents. An alternative surgical method in phimosis is a ventral slit of the prepuce. When properly indicated, an almost normal appearance of the prepuce is preserved. This operation was performed in 25 boys. An ideal result, where an almost normal shape of the prepuce is preserved and the latter can be drawn over the glans, was achieved in 19 patients. In four boys the prepuce can be freely drawn over the glans but a slight strangulation ring forms. A relapse of phimosis occurred in two boys. The authors recommend to use ventral slit of the prepuce instead of circumcision in children with phimosis, when the prepuce is sufficiently long. The method is not suitable for short prepuces with cicatricial phimosis.

Child↗
PubMed2005

Phimosis: stretching methods with or without application of topical steroids?

Phimosis has been defined as unretractable foreskin without adherences or a circular band 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, prospective, 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).

Administration, Topical↗
PubMed2005

Phimosis. Preputial plasty using transversal widening on the dorsal side with EMLA local anesthetic cream.

BACKGROUND/PURPOSE: In the United States, the treatment of choice for the correction of phimosis is circumcision, whereas in European countries, the condition is usually treated by preputial plasty using Duhamel's method or modified versions. We report our experience in correcting phimosis by preputial plasty using transversal widening on the dorsal side with EMLA local anesthetic cream. METHODS: Twenty-six patients with phimosis were operated on by preputial plasty, under local anesthesia with EMLA cream. A transversal incision is made on the dorsal side of the ring of prepuce, like 3 contiguous Ts, the middle one inverted with the long arm on the preputial mucosa side. The 2 small mucocutaneous flaps of the prepuce are separated and then sutured with interrupted stitches, thus transforming the incisions from T to V. RESULTS: No postoperative complications were observed. At 1-year follow-up, the cosmetic and functional results were satisfactory. CONCLUSIONS: The technique of preputial plasty that the authors present enlarges the stenotic ring of prepuce by a transversal widening on the dorsal side. The ring of prepuce obtained is wide and symmetrical on its dorsal and ventral sides and therefore cosmetically and functionally satisfactory. It is a good alternative to the more radical circumcision technique.

Anesthetics, Local↗
PubMed1994

Lichen sclerosus et atrophicus causing phimosis in boys: a prospective study with 5-year followup after complete circumcision.

We prospectively investigated 100 pediatric patients suffering from phimosis and found a 10% incidence of lichen sclerosus et atrophicus. This condition usually can be diagnosed preoperatively because of its classic manifestation of severe phimosis due to a sclerotic, whitish ring at the tip of the prepuce, which in our cases was accompanied by sclerogenous glanular lesions. To our knowledge our study represents the first evidence that the development of secondary phimosis with no apparent reason in school-age boys is highly suggestive for lichen sclerosus et atrophicus. Complete circumcision is the therapy of choice because it completely removes all affected tissue and it allows spontaneous regression or resolution of glanular lesions. There has been no recurrence after 5 years of followup.

Adolescent↗
PubMed2001

Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect.

OBJECTIVE: To compare the cost-effectiveness of surgery and topical steroids as treatments for phimosis (defined as a clinically verifiable, pathological, cicatricial stenosis of the prepuce) and to evaluate the financial basis of these treatments. METHODS: Data on treatment using topical steroids was obtained from published reports and those for circumcision from claims by private hospitals for children < 13 years old registered at the health insurance department of our facility. The estimate of the French national financial cost of the treatments for 1998 was calculated from public and private institutional information. RESULTS: Treatment with topical steroids for 4-8 weeks was successful in approximately 85% of patients (mean age 5 years) and had no side-effects; the remaining 15% were treated by circumcision. Topical steroid therapy costs (in French francs) F 360 per patient. For those primarily treated by circumcision (81 boys, mean age 4.3 years) and diagnosed as having phimosis, the cost was F 3330 per patient in the private sector. The total number of circumcisions performed in France, regardless of sector (public or private) for 1998 was estimated to be 51 080, which represents an annual cost of F 195.7 million. CONCLUSION: As topical pharmacological treatment avoids the disadvantages, trauma and potential complications of penile surgery, including anaesthesia-related risks, the use of topical steroids as a primary treatment appears to be justified in boys with clinically verifiable phimosis. This treatment could reduce costs by 75%, which represents a potential annual saving of approximately F 150 million.

Adolescent↗
PubMed2005

Highly potent and moderately potent topical steroids are effective in treating phimosis: a prospective randomized study.

PURPOSE: We report a prospective randomized study comparing the effects of highly potent and moderately potent topical steroids in treating pediatric phimosis. MATERIALS AND METHODS: A total of 70 boys 1 to 12 years old with phimosis were randomly 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 graded 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.

Administration, Cutaneous↗
PubMed1981

Special surgical techniques for relief of phimosis.

Almost one-half of the population of adolescent and adult Japanese males suffers from some degree of phimosis, i.e., the condition in which the prepuce is too long or too tightly covers the glans penis and causes complications. This condition makes local hygiene difficult, promotes secondary infection and purulence, retards maturation of the penis, and leads to sexual dysfunction that is psychologically and maritally distressing. Circumcision shortly after birth is not ordinarily praticed in Japan, and when relief of phimosis and its complications is attempted later in life by the conventional technique of circumcision or by limited operations like dorsal slit of the prepuce or incision of the frenulum of the prepuce, the condition and its related problems are not readily or always satisfactorily corrected. Consequently, new surgical techniques have been devised and are practiced at the Ohjimi Clinic for the relief of phimosis, especially for the sexual dysfunction that results from it.

Adolescent↗
PubMed2001

[Treatment of phimosis with betamethasone ointment in children].

OBJECTIVE: We evaluated the efficacy of betamethasone ointment in the treatment of childhood phimosis and determined the most effective concentration of betamethasone. MATERIAL AND METHODS: Between August 1996 and May 2000, 69 patients (median age 3.0, range 0-12) presented to our department with severe phimosis (grade 4, Tsugaya's classification), and were enrolled in this study and treated with betamethasone ointment for 4 weeks. The ointment was applied on the narrowed preputial skin twice a day by parents. During the first week, parents were asked not to retract the foreskin. After this period, parents were encouraged to retract the foreskin gently and without intense tension. The concentration of betamethasone were 0.12%, 0.05% and 0.025%. If the patients become to be able to retract foreskin satisfactory, we consider the state as complete response. If he become to be able to retract to allow partial exposure of the glans, we consider the state as partial response. We compared the efficacy among each of the concentrations, and at 3 months after the end of the treatment, we also assessed the adverse effects and recurrence. RESULTS: The overall success rate was 85.5%. Success rates with 0.12%, 0.05% and 0.025% ointment were 96.8%, 82.8% and 55.6%, respectively (p = 0.0001). The 0.12% ointment was most effective. Recurrence was observed in 3 patients (4.3%). No adverse effects were observed in any of the patients. CONCLUSIONS: Treatment with betamethasone ointment is very effective, easy and safe. We recommend betamethasone ointment as the first treatment of choice for childhood phimosis.

Betamethasone↗
PubMed1992

Lichen planus: an unusual cause of phimosis.

We report on a 47-year-old man with oral and genital lichen planus. After some months of the disease, increasing phimosis developed which had not been present before. Retraction of the foreskin was now impossible and sexual intercourse was painful. Treatment with triamcinoloneacetonide and etretinate ameliorated the phimosis but the patient was still not comfortable and circumcision was performed. Histology from the foreskin revealed the typical picture of lichen planus. No features of lichen sclerosus et atrophicus were present. This is the first published observation of phimosis as a result of lichen planus.

Humans↗
PubMed2004

[Treatment for phimosis with an estrogen-containing ointment in children].

We evaluated the effectiveness of topical application of an ointment containing 0.1% estrogen for phimosis in children. Fifty children 1 to 12 years old (average age 4 years) presenting to our department with phimosis were enrolled in this study and treated with an estrogen-containing ointment for 4 weeks. The ointment was applied on the narrow preputed skin twice a day by the child's parents. The success rate was 82%. There were no side effects. The application of an estrogen containing ointment is a viable alternative for treating phimosis in children.

Administration, Cutaneous↗
PubMed1994

[Ritual circumcision and the plastic repair of phimosis].

The AA. describe two variations of their personal technique of foreskin plasty for phimosis treatment. They utilize a variation of Duhamel procedure, with incision of foreskin dorsal face in italic S in cases where the striction ring is moderate and allows a slipping with glandular exposure. They resected ad minima the foreskin in the cases of very serious phimosis and make a YV plasty on the dorsal face, and if necessary a small excision à la demande of the remaining ventral skin. They achieve a good aesthetic result in both techniques and most of operated cases are hard to distinguish from a normal foreskin. The plasties with foreskin maintenance tend to be used in the modern European culture, where the rites disappeared and hygienic habits gained roots. With the exception of religious reasons or strict medical indications (diabetes, skin lesions, etc.) the phimosis repair by mutilation procedures tends to disappear.

Circumcision, Male↗
PubMed1997

[Phimosis can be treated with local steroids].

The effectiveness of topical steroid application in relieving phimosis was studied in 41 boys treated with a potent steroid ointment. 35 patients showed improvement initially but in 12 of them the phimosis recurred completely and in seven of them partly. There was significantly less recurrence in the patients who improved within one month. Most of the families were satisfied with the treatment. We recommend topical steroids as first treatment of choice for phimosis, when treatment is necessary.

Administration, Topical↗
PubMed1984

Lichen sclerosus et atrophicus. A common and distinctive cause of phimosis in boys.

Lichen sclerosus et atrophicus, a disease said to be rare in boys, was found in 14 of 100 prepubertal boys undergoing elective circumcision for disease of the foreskin. The clinical features of the disease, in particular the acquired scarring phimosis of the tip of the prepuce, were distinctive. Extragenital involvement was not found. Scarring phimosis in boys must be considered to be one of the most common manifestations of lichen sclerosus et atrophicus.

Adolescent↗
PubMed2003

Triple incision to treat phimosis in children: an alternative to circumcision?

OBJECTIVE: To evaluate the functional and cosmetic results and patient satisfaction after triple incision plasty for phimosis in children. PATIENTS AND METHODS: The study included 197 boys who had a triple incision for phimosis (mean age 5.8 years, range 0.25-18). The indications for preputial surgery were recurrent balanoposthitis, ballooning during micturition and severe phimotic stenosis. The results after surgery were assessed using a questionnaire about the child's/parent's satisfaction, and an outpatient follow-up examination for functional and cosmetic preputial appearance. RESULTS: Of 128 parents/children responding, 108 (84%) were satisfied with the function and 102 (80%) reported a good cosmetic outcome. Triple incision as preputioplasty would be recommended to other parents by 119 (93%) respondents. Ninety-one (71%) of the parents feared disadvantages in their son's later life if the child had been circumcised. The outpatient examination showed an excellent functional and cosmetic outcome in 71 (77%) of the children. CONCLUSION: Triple incision is a simple, fast and safe technique for preputial relief, with good functional and cosmetic results, and was well accepted by the patients.

Child↗
PubMed1987

[Lichen sclerosis et atrophicus as a cause of acquired phimosis--circumcision as a preventive procedure against penis cancer?].

From January to December 1985, circumcision for acquired phimosis was performed at our department in 140 boys with a median age of 4 3/4 years. The histological examination of the prepuce revealed the existence of lichen sclerosus et atrophicus (LSA) in 6 cases, e.g. 4.3% of all circumcisions performed. The striking frequency of this chronic inflammatory epithelial change and the often cited connection between the existence of LSA and the development of penile cancer during adulthood as well as the well-known tendency towards the incidence of recurrent phimosis in LSA patients support the claim for total circumcision in these cases.

Adolescent↗
PubMed1986

Circumcision for phimosis--indications and results.

A follow-up study including all boys (n = 117) operated with circumcision for phimosis during 1976 was performed. Most patients were operated on an outpatient basis. Early complications like bleeding or infection were few and mild. In 13 cases there was a postoperative stricture of the urethral orifice which had to be widened. Five patients had complaints about the cosmetic result. Eight boys expressed shyness and unwillingness to undress in school gym. In no instance were there any signs of a more serious psychological disorder. The operative indications are discussed and it is concluded that worried parents of boys with phimosis can be safely advised to have their boys circumcised if the prepuce is scarred or there has been recurrent balanitis, or if the boy has reached school age and the foreskin is still unretractable.

Child↗
PubMed2001

A conservative treatment of phimosis in boys.

OBJECTIVE: The aim of this study was to evaluate the efficacy of topical applications of clobetasol propionate cream in the treatment of phimosis in boys and a comparison of the results presented with an overview of the current studies. METHODS: In a prospective study, 94 boys (mean age 5.5 years) were treated with topical applications of 0.05% clobetasol propionate cream twice daily. The prepuce was treated for 1 month, with an attempt at prepuce retraction after 14 days. The boys were evaluated after 1 month of treatment and every 3 months during follow-up. RESULTS: Of the 94 boys, 91 were available for follow-up, of whom 42 boys (46.1%) achieved complete retraction of the prepuce, 24 (26.4%) had only preputial adhesions and 4 (4.4%) had partial retraction. Twenty-one boys (23.1%) had no response. The treatment was continued in 13 boys with good results eventually. Seven boys (7.7%) had recurrence after a mean follow-up of 4.3 months (range 2-7). No side effects were noted. Circumcision was necessary in 24 of the 91 boys (26.4%). The mean follow-up was 11.0 months (range 3-18). CONCLUSIONS: Local application of clobetasol propionate cream is a simple, safe and effective treatment for phimosis in boys and avoids circumcision and its associated risks. It should be offered first instead of circumcision.

Administration, Topical↗