Role of application of Topical steroids in Management of Phimosis in Pediatric age Group

Dr Jatin Modi; Dr Jaimin Shah; Dr Mehul Mehta; Dr Krunal Chandana

Volume : IV, Issue : VII, July - 2015

Role of application of Topical steroids in Management of Phimosis in Pediatric age Group

Dr Jatin Modi, Dr Jaimin Shah, Dr Mehul Mehta, Dr Krunal Chandana

Abstract :

Background and Objectives: Phimosis is nonretraction of prepuce. It is normally seen in younger children due to adhesions between prepuce and glans penis. It is termed pathologic when nonretractability is associated with local or urinary complaints attributed to the phimotic prepuce. Physicians still have the trouble to distinguish between these two types of phimosis. This ignorance leads to undue parental anxiety and wrong referrals to urologists. Circumcision was the mainstay of treatment for pathologic phimosis. With advent of newer effective and safe medical and conservative surgical techniques, circumcision is gradually getting outmoded. Parents and doctors should a be made aware of the noninvasive options for pathologic phimosis for better outcomes with minimal or no side-effects. Also differentiating features between physiologic and pathologic phimosis should be part of medical curriculum to minimise erroneous referrals for surgery. Methods: Study was conducted on patients that presented in Smt. NHL Municipal Medical College-Smt SCL Hospitalfrom the period of 2 years, September 2011 to September 2013 of a total 82 cases. Case selection was done by detailed history, clinical examination,treatment consisted of the application of topical steroid three times a day, particularly at night before going to bed and followed up regularly at 1 week, 2 week and 1 month in necessary individuals. Routine investigations and other investigation protocols according to the further management were duly carried out. Results: 85% of patients had physiologic phimosisand 9% presented with pathological or acquired Phimosis.Most common symptom was irretractability 93%, and ballooning 35% as symptoms.83% of patients were willing to undergo conservative line of management as first line of treatment, though 22% defaulted with poor adherence to therapy.51 out of 53 patients who completed the course (96%) achieved success with conservative line of treatment. Only 2 failures was seen (4%). 72.5% patients who underwent conservative line of treatment responded successfully within 2 weeks of treatment. 27.5% patients took 1 month of therapy to be successful. Conclusion: Topical steroid for the treatment of phimosis is a safe, simple, and inexpensive procedure that avoids surgery and its associated risks. It is effective both in primary and in secondary phimosis.The importance of proper and regular foreskin care is the main mechanism of action of the steroids.