- Lane S Palmer: Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA.
OBJECTIVES: To compare the efficacy of two different topical betamethasone treatment regimens with respect to outcome and untoward effects in boys with phimosis.
METHODS: Boys with phimosis whose parents opted for medical management were treated with topical betamethasone (0.05%) and manual retraction. One author (J.S.P.) prescribed betamethasone twice daily (BID) for 30 days (60 doses), and the other author (L.S.P.) prescribed betamethasone thrice daily (TID) for 21 days (63 doses). All boys had severe phimosis (prepuce unretractable to evaluate meatus) before treatment. The degree of phimosis was graded 1 month after treatment as severe, moderate (prepuce retractable to less than 50% glanular exposure), or mild (penile adhesions). Chi-square analysis (P <0.05) was used to compare the two groups. Treatment failure was defined as persistent severe phimosis.
RESULTS: A total of 200 consecutive patients from each treatment group were included. The median patient ages were similar between the groups (3.8 years BID, 4.4 years TID). One child had an untoward effect (candidal dermatitis, TID regimen). There was an 84.5% response rate (moderate to no phimosis) with the BID regimen and an 87% response rate with the TID regimen (P = nonsignificant). Two patients with severe phimosis before treatment were diagnosed with congenital urethral malformations (hypospadias and epispadias) after treatment.
CONCLUSIONS: The topical application of betamethasone is a highly efficacious, safe, and well-tolerated treatment of phimosis in this large series of boys. The 21-day TID and 30-day BID regimens in conjunction with manual retraction are equally efficacious and can be offered to parents requesting nonsurgical management of phimosis. Untoward effects are rare with either regimen. Important urethral anomalies can occasionally be revealed.