The use of steroids in the treatment of phimosis in children

Bukhmin A.V., Rossikhin V.V., Sumanov S.V. Kharkov Medical Academy of Postgraduate Education.

Introduction. The standard approach to the problem of phimosis predetermines the choice of surgical treatment tactics, and circumcision is performed in almost all cases. However, the prevalence of phimosis indicates the physiology and functionality of this condition, which resolves naturally. At birth, the penis is not fully formed, and the process of development of the penis occurs during the first years of life. At the same time, the relatively large length of the foreskin (PF) should not be regarded as a pathology.

Materials and methods. The study examined the effectiveness of the steroid ointment "Pimafucort" (Astellas) in the treatment of phimosis in 253 children. The age of the patients studied was from 1 to 15 years: 1-3g – 82 (32.4%); 4-7 years – 123 (48.6%); 8-10 years – 31 (12.3%); 11-15 years old – 17 (6.7%). 27 (10.7%) children were admitted to the clinic with balanoposthitis; in 15 (5.9%) type I diabetes mellitus was a concomitant disease.

"Pimafukort" is a combination drug that contains natamycin, neomycin sulfate, and micronized hydrocortisone. The components included in the composition have an antimicrobial, antifungal, anti-inflammatory effect, and also help restore the balance of collagen synthesis by fibroblasts.

Results and its discussion. According to our studies, when treating congenital phimosis by circumcision, or after ritual circumcision, the structure of the joint had a morphologically unchanged picture with the presence of loose fibrous connective tissue at the base. The unchanged histological picture of the KP justifies conservative treatment of phimosis, moreover, this reduces the risk of complications associated with surgical treatment.

In the main group, already 4 weeks from the start of phimosis therapy, in 187 (75.5%) cases a positive effect was achieved - the penis became more elastic and pliable to stretching, and the head of the penis began to be exposed by 1/3 or more. These children subsequently underwent bloodless expansion of the CP on an outpatient basis.

In 48 children of the main group, the head of the penis did not “open”, however, it was noted that the penis became more elastic, and the length of the “proboscis” of the penis decreased. In these observations, treatment was continued. An examination after 8 weeks showed that in another 30 children the head of the penis began to be exposed. Thus, the total number of positive results was 217 (85.7%).

In the comparison group, where traditional treatment was carried out, a positive result was achieved after 4 weeks in 12 (16%), and after 8 weeks - in 26 (34.6%) children. In addition, in 5 (6.7%) children, “zealous” attempts to stretch the CP were complicated by paraphimosis.

The use of Pimafukort ointment in the treatment of balanoposthitis showed that already on the 2nd day there was a pronounced therapeutic effect, on the 5th day inflammation was not detected. Treatment of balanoposthitis turned out to be just as effective in patients with diabetes. At the same time, the further use of Pimafukort for phimosis in patients with diabetes mellitus made it possible to avoid surgical treatment in 8 (53.3%) children.

In 36 (14.2%) boys the expected therapeutic effect was not achieved; the children underwent surgical treatment. Histological examination of the CP in these patients revealed pronounced coarsening of collagen fibers with the formation of extensive fields of hyalinosis.

Conclusions. Conservative treatment of phimosis in children is justified from the point of view of the physiology of penile development and is morphologically justified. The positive effect of conservative treatment of phimosis in children using Pimafukort ointment is 85.7%, which allows us to recommend this method of treatment in clinical practice.

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Abstracts: V Anniversary All-Russian School of Pediatric Urology-Andrology - 2016

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Is it possible to cure phimosis without surgery?

If we are talking about mature phimosis in an adult man (that is, the impossibility of exposing the head of the penis), then there is no alternative to surgical treatment.

The use of corticosteroid ointments, which many patients rely on, is effective only when the foreskin is narrowed - when exposure of the head is difficult, but still possible, and the functions of the penis are not impaired. The same is true for such physiotherapeutic methods of treating phimosis as phonophoresis or stretching with a button probe.

With physiological phimosis, which is observed in almost all newborn boys and goes away on its own by 3-5 years (in rare cases by 16-17), only medical supervision is indicated.

Additional measures

To eliminate infectious complications of phimosis, antibacterial ointments are used: betadine, dioxidine, ichthyol ointment, zinc ointment, resorcinol and others. Before using each drug, you need to study its instructions, since many drugs have age-related contraindications .

Together with the use of steroid ointments, non-surgical treatment of phimosis involves another procedure - daily stretching of the foreskin. The method of its implementation is shown by the urologist at the appointment.

The general principle of stretching is to spread the opposite edges of the preputial sac in different directions with your fingers, but you should not separate them so much that pain occurs.

After taking water procedures, the effectiveness of the procedure increases.

The stretching should be done by the child himself, and not by his parents, since only small children's fingers can penetrate the insides of the foreskin.

The first results of this method appear after a few months, provided that the procedures are carried out regularly and correctly. Read more about the methods and means used in conservative treatment here.

For what reason does it occur, and is it necessary to treat phimosis in boys:

up to 1 year;
from 1 year to 3 years;
from 4 years to adolescence.

Read about the fact that phimosis can serve as a prerequisite for the development of paraphimosis.

List of ointments

Hormonal ointments based on corticosteroids are used to treat phimosis. These substances slow down protein synthesis in tissues, which leads to a reduction in swelling and inflammation. Corticosteroids make the skin thinner and more elastic.

Antiseptic ointments are also used for phimosis if bacterial complications occur.

Corticosteroid ointments for phimosis in boys:

Hydrocortisone.
Betamethasone.
Prednisolone.

Help : most hormonal ointments are sold in pharmacies only by prescription.

A large number of drugs are produced based on these substances.

Below are the remedies that are best suited for treating children.:

Cloveit. Ointment for phimosis for children based on clobetasol propionate.
It is used 1-2 times a day, depending on the age and severity of phimosis, the course of treatment lasts from two weeks to a month.
The effect of the ointment can be enhanced by applying an occlusive dressing to the foreskin, but this can only be done on clean skin.
Cloveit is well suited for forms of the disease characterized by thickening of the epidermis.
The product is contraindicated in children under one year of age. Price – 300 rubles.

Beloderm. Cream based on betamethasone.
The active substance content is 0.05%.
The cream is applied to the foreskin with rubbing movements twice a day, the course of treatment is 2-4 weeks.
The product is effective even for treating severe inflammation.
Applying an occlusive dressing when using Beloderm on children's skin is not recommended, as this increases the likelihood of absorption of the drug into the blood.
The cream is contraindicated for children under 6 months. Price – 200 rubles.

Elokom. Cream based on mometasone.
Apply to the foreskin once a day.
The use of occlusive dressings is permissible with caution.
This product contains propylene glycol stearate, which may cause skin irritation.
If this occurs, you need to stop taking the drug and use another remedy.
Elokom is contraindicated for children under 2 years of age. The price of the cream is 350-450 rubles.

Diprosalik. The ointment contains not only the corticosteroid betamethasone, but also salicylic acid.
This acid softens the skin and improves local absorption of the hormone.
The course of treatment depends on the further development of phimosis; if the ointment is used for a long time, then therapy should be discontinued gradually.
Diprosalik for phimosis in a child is used 2 times a day (morning and evening) or 1 time a day (preferably in the evening).
Bandaging the foreskin is not recommended.
The drug has no age-related contraindications, but in infancy it is used with great caution. Price – 600-700 rubles.

Hydrocortisone ointment. It is based on the corticosteroid of the same name.
Its anti-inflammatory activity is relatively low, but the likelihood of side effects is less than that of more potent analogues.
The ointment is available in concentrations of 0.5% and 1%; 1% ointment is used to treat phimosis.
Apply to the skin once a day; applying a bandage is prohibited, since hydrocortisone is well absorbed on its own.
The drug is contraindicated for use under the age of two years. Price – 40-80 rubles.

Advantan. Ointment for phimosis for children based on methylprednisolone.
A characteristic feature of the product is the presence of a fat-saturated version.
It is suitable for cases where phimosis is associated with dry skin.
The ointment is applied to the foreskin once a day.
The course of treatment lasts no more than one month.
Advantan is contraindicated in children under 4 months. Price 500 rubles.

Lokoid. Cream based on hydrocortisone butyrate.
This is a relatively safe product to use, which makes it possible to use it frequently, up to 3 times a day.
The course of treatment is 4 weeks, the first results are observed after 2 weeks.
Read also: Monastic tea - what it is, beneficial properties of what herbs it consists of
Lokoid is approved for use from 6 months.
On average, the cream costs 300 rubles.

Lorinden A. The ointment contains flumethasone and salicylic acid.
As in Diprosalik, salicylic acid acts as a catalyst for the effects of the corticosteroid.
Lorinden is used 2-3 times a day, the application of an occlusive dressing is allowed.
The effectiveness of the ointment is high, but its negative impact on the body is also great, so full use of the drug is possible only from 3-4 years.
The price is 400 rubles.

When using steroid ointments, you need to ensure that they are applied only to the foreskin and not on the head of the penis, their effect can damage it and lead to systemic side effects due to rapid absorption into the delicate tissues of the head.

Important! if an infectious focus (fungal, viral or bacterial) has arisen in the preputial area, then the use of corticosteroids of any type is contraindicated until it is eliminated.

This is due to the fact that steroid hormones weaken systemic and local immune defenses, thereby creating a favorable environment for the further development of infection.