SEARCH · PubMed Health

Results for “PHIMOSIS”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources

PubMed2005

Phimosis--a diagnostic dilemma?

INTRODUCTION: Phimosis is defined as the inability to retract the foreskin. Differentiating between physiological phimosis and pathological phimosis is important, as the former is managed conservatively and the latter requires surgical intervention. Referrals of patients with physiological phimosis to urology clinics may create anxiety regarding the need for surgery amongst patients and parents, while unnecessarily expanding the waiting list for specialty assessment. OBJECTIVES: To determine the ability of referring physicians to differentiate physiological from pathological phimosis, and to see whether there is any difference in this ability between generalists versus specialists. MATERIALS AND METHODS: A retrospective chart review of 284 consecutive referrals for phimosis to the Children's Hospital of Eastern Ontario (CHEO) Urology Clinic during November 2000 - April 2003 was conducted. Referral sources included family physicians (FP), pediatricians (PD), emergency physicians (ER), and other subspecialists (SS). Data for this study were obtained from the original referral letters and cross-referenced with the impressions of the pediatric urologist following the initial patient encounter. The accuracy in diagnosing phimosis was evaluated among the various types of referring physicians. RESULTS: A total of 284 phimosis referrals were reviewed of patients ranging from 2 months to 16 years of age (mean = 6.6 years). The referral sources consisted of 222-GP, 33-PD, 23-ER, and 6-SS. The majority of referred cases were diagnosed by the attending pediatric urologist as physiological phimosis across all referral sources, with the exception of subspecialists (FP = 75.2%, PD = 81.8%, ER = 56.5%, SS = 33.3%). Second to this was the diagnosis of pathological phimosis across all referral sources except SS (FP = 14.9%, PD = 12%, ER = 34.8%, SS = 50%). Overall, the circumcision rate for the 284 phimosis referrals reviewed was 14.4%. CONCLUSIONS: Our findings reveal that many physicians continue to face difficulties in distinguishing physiological phimosis from the pathological. As a result, many unnecessary referrals are made for phimosis . We suggest the implementation of improved educational measures regarding preputial pathophysiology in the medical curriculum. Such measures would serve two purposes: first, to reduce the number of unnecessary specialty referrals and secondly, to aid primary care physicians in recognizing the presence of physiological phimosis so that patients and families may be reassured of normalcy.

Adolescent↗

PubMed1994

[Phimosis as a pathogenetic factor in urinary tract infection and vesicoureteral reflux].

The present study has been carried out to clarify relationship between phimosis and urinary tract infection or vesicoureteral reflux. The subjects consisted of 654 boys up to 15 years old with phimosis who had been treated at the outpatient division, Fukuoka University Hospital during 13 years from 1974; 393 boys (60%) with false phimosis, 261 boys (40%) with true phimosis. Thirty three cases (5%) had abnormal voiding (weak stream, preputial ballooning, dribbling etc.) Boys with true phimosis without abnormal voiding showed high incidence of urinary tract infection compared with normal subject, and if these boys had abnormal voiding symptoms as well, the incidence of urinary tract infection, particularly in the form of pyelonephritis, was noted to be high. Therefore, we suggest that boys with phimosis should be treated surgically. The incidence of urinary tract infection in boys with false phimosis were similar to normal group. All cases except one of vesicoureteral reflux accompanied by true phimosis was diagnosed as primary reflux cystoscopically. Therefore in most cases of phimosis associated with reflux, phimosis is determined to be only an accessory factor of vesicoureteral reflux. And refluxing patients should be worked up for urinary tract infection after they have had circumcision. Only in one boy with phimosis and reflux, was the reflux thought to be secondary reflux caused by phimotic obstruction.

Adolescent↗

PubMed2003

Outpatient management of phimosis following newborn circumcision.

PURPOSE: We reviewed our experience in treating patients with a trapped penis due to phimosis following newborn circumcision. The outcome of treatment of this condition at the outpatient clinic was examined. Possible etiological factors leading to this complication were determined. METHODS: A total of 521 pediatric patients underwent Gomco circumcision while under local anesthesia at our outpatient clinic between 1994 and 1999. Phimosis was noted in 15 patients (2.9%), and an additional 13 patients were referred to our clinic with phimosis after undergoing circumcision elsewhere. These 28 patients underwent treatment for the phimosis at the outpatient clinic. The phimotic ring was manually dilated with a fine hemostat. Careful traction with sterile gauze was then used to reduce the phimotic band below the glans penis. No evidence of glans ischemia was noted. Mild edema of the pericoronal skin collar was common. Cases referred after age 6 months or those weighing more than 14 pounds were treated as an elective outpatient surgical procedure. RESULTS: Three patients had recurrence of the phimosis. These cases were managed with manual retraction of the prepuce at the clinic. At 1 month followup 27 patients had resolution of the phimosis. One infant was lost to followup. Factors contributing to development of phimosis after newborn circumcision were reviewed. Ten of the patients had obvious poor penile skin attachment with concealment of the penis even after resolution of the phimosis. Phimosis occurred more frequently in older patients undergoing circumcision-15 patients were older than 1 month at circumcision. Mean body weight of the latter group at circumcision was 12 pounds. CONCLUSIONS: Phimosis with a trapped penis is an infrequent but important complication of circumcision. This condition is more likely to occur in older infants and those with poor attachment of the penile skin to the shaft. Early recognition allows outpatient treatment with excellent results, avoiding operative intervention with general anesthesia.

Ambulatory Care↗

PubMed2005

[Phimosis: medical treatment or circumcision?].

Phimosis remains a major question for mothers and induces a high number of consultations. However, large epidemiologic series have shown that congenital phimosis may disappear spontaneously in around 80% of cases with development and should'nt need any treatment before the age of five or six years old. Theses elements go against sociocultural habits which induce many circumcisions before the age of six. Corticoid treatment of phimosis seems to be very efficient to facilitate the disparition of phimosis. The aim of this literature review is to evaluate medical, socioeconomical and therapeutics aspects of phimosis. Based on these data, we recommend never to treat phimosis before the age of one year old, to wait as long as possible for spontaneous evolution of phimosis until the age of five years old, and, in case of non evolution of congenital phimosis or pathologic phimosis to use as first step treatment corticoid topics rather than surgical treatment.

Age Factors↗

PubMed2003

Circumcision for phimosis and other medical indications in Western Australian boys.

OBJECTIVE: To investigate the incidence rate of circumcision for phimosis and other medically indicated reasons in Western Australian boys from 1 January 1981 to 31 December 1999. DESIGN AND SETTING: A population-based incidence study using hospital discharge data of all circumcisions performed in all WA hospitals during the study period. MAIN OUTCOME MEASURES: Changes in the incidence rate of circumcision for medically indicated reasons. RESULTS: The rate of medically indicated circumcisions increased in boys aged less than 15 years during the study period. Phimosis was the most common medical indication for circumcision in all age groups. The rate of circumcision associated with phimosis was eight times that associated with balanoposthitis and 21 times that of balanitis xerotica obliterans. Boys aged less than five years had the highest rate of circumcision to treat phimosis, at 4.6 per 1000 person-years, representing about 300 circumcisions per year. Boys aged less than five years living in country areas were 1.5 times more likely to be circumcised for phimosis than boys living in metropolitan Perth. CONCLUSION: The rate of circumcision to treat phimosis in boys aged less than 15 years is seven times the expected incidence rate for phimosis. Many boys are circumcised before reaching five years of age, despite phimosis being rare in this age group.

Adolescent↗

PubMed1999

Topical steroid treatment of phimosis in boys.

PURPOSE: We evaluate whether steroid application alone or retraction and hygiene are responsible for successful results in boys treated with topical steroids for phimosis. MATERIALS AND METHODS: A prospective 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 candidates for steroid treatment.

Administration, Topical↗

PubMed2002

Lichen sclerosus et atrophicus in children with phimosis and hypospadias.

This prospective study was designed to evaluate the incidence of lichen sclerosus et atrophicus (LSA) in a pediatric population with hypospadias and phimosis in order to discuss the indications for circumcision and utilization of preputial skin for urethral surgery. All 115 boys, 55 with congenital phimosis, 45 with acquired phimosis, 13 with hypospadias, and 2 with recurrent chronic balanitis, underwent full-thickness biopsies of the foreskin that were examined by a single pathologist. Of the patients with acquired phimosis, 88% showed inflammatory features in the foreskin; 60% had LSA. Of the patients with congenital phimosis, 82% showed inflammatory disease in the prepuce; 30% had LSA. Of the patients operated upon for hypospadias, 61% showed histologic findings of chronic inflammation of the foreskin and LSA was evident in 15%. The high incidence of LSA in the prepuce of patients with phimosis suggests that circumcision should be performed to correct this disease. The frequent presence of chronic inflammation is a possible cause of stenosis when the foreskin is used to perform a urethroplasty in patients with hypospadias.

Adolescent↗

PubMed2000

Conservative treatment of phimosis in children using a topical steroid.

OBJECTIVES: From 1997 through 1998, we conducted a prospective study to evaluate the long-term outcome of using topical steroids in the treatment of childhood phimosis. METHODS: Both the parents and their children were instructed to apply 0.05% betamethasone cream topically twice a day for 1 month and to retract the prepuce after the fifth day of treatment. Results were evaluated at the end of the treatment and 6 months later. RESULTS: One hundred thirty-seven boys were evaluated. The median age was 5.4 years. At initial presentation, 61 boys had a phimotic but retractable prepuce, 37 had a nonretractable phimotic ring, and 39 had a pinpoint opening. Patients with a history of previous forcible foreskin retractions were considered to have secondary phimosis. By 6 months following treatment, 90% (124 children) had an easily retractable prepuce without a phimotic ring. No differences were seen in the response rate between those with primary and secondary phimosis. In all cases, the treatment was well tolerated without local or systemic side effects. All the patients with persistent or recurrent phimosis were found to be noncompliant with the suggested daily foreskin care. CONCLUSIONS: 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. We emphasize the importance of proper and regular foreskin care and hypothesize on the mechanism of action of the steroids.

Administration, Topical↗

PubMed1999

The incidence of phimosis in boys.

OBJECTIVE: To establish the incidence of pathological phimosis in boys. PATIENTS AND METHODS: A 2-year review of circumcisions was performed for phimosis among a known population of boys, with the histological findings of the circumcision specimens assessed. RESULTS: Sixty-two boys (all but one aged 5-14 years) had typical pathological (cicatrizing) phimosis and among the 51 circumcision specimens examined histologically, 43 (84%) showed appearances of balanitis xerotica obliterans. During the same period, 30 boys were circumcised for developmental unretractability of the foreskin ('physiological phimosis'). CONCLUSIONS: The incidence of pathological phimosis in boys was 0.4 cases/1000 boys per year, or 0. 6% of boys affected by their 15th birthday, a value lower than previous estimates and exceeded more than eight-fold by the proportion of English boys currently circumcised for 'phimosis'.

Adolescent↗

PubMed2003

Treatment of phimosis with topical steroids in 194 children.

PURPOSE: Topical steroids have been advocated as an effective economical alternative to circumcision in boys with phimosis. We evaluated the effectiveness of topical steroid therapy as primary treatment in 194 patients with phimosis. METHODS: Between January 1996 and November 2000, 228 boys 16 years old or younger were referred for consideration of circumcision. When intervention was determined to be necessary, a 6-week course of topical steroids was used as primary treatment. Efficacy of treatment was evaluated at 3 months from initiation of therapy. RESULTS: Of the 228 patients 15 had such a mild degree of phimosis that no intervention was believed to be necessary, 19 were scheduled directly for circumcision due to cosmetic reasons, parent wishes, or severe phimosis with associated voiding problems and the remaining 194 received topical steroids as primary treatment. Of these 194 patients 25 had coexisting balanitis and 4 had a history of urinary tract infection. Conservative treatment was successful in 87%, 88% and 75% of patients with phimosis alone, coexisting balanitis and history of urinary tract infection, respectively. Overall, circumcision was avoided in 87% of patients treated with topical steroids. CONCLUSION: Topical steroids are becoming the standard conservative measure for treating phimosis. Our study supports this trend, with an overall efficacy of 87%.

Administration, Topical↗

PubMed2001

[Treatment of phimosis with a steroid creme in boys].

UNLABELLED: The current treatment of phimosis in Denmark is surgical. Reports of success rates of 70-80% with topical steroids have prompted us to carry out the present study. METHODS: Parents of boys, who were referred because of phimosis, volunteered to participate in an open trial of topical clobetasol 0.05%, along with gentle mobilisation of the foreskin once daily for 4-6 weeks. Fifty-five boys completed the treatment. The results were recorded at clinical follow-up four and six weeks later, and a long-term follow-up was done by questionnaire sent after 9-11 months. RESULTS: At six weeks of treatment, 42 had a fully retractable foreskin, 11 a partially retractable foreskin, and two had unchanged phimosis. Ten patients had a circumcision or plasty. At long-term follow-up, 12 had a symptomatic recurrence. Four of these were given surgical treatment and eight had a repeat topical treatment, which was effective in six. The overall effect was independent of the degree of phimosis. Four patients with obvious sacrified foreskin failed. Twelve patients had agglutinations, which became apparent after the treatment for phimosis. We recorded no systemic and very few local side effects. The patients and parents found the treatment convenient and satisfactory. CONCLUSION: Topical clobetasol 0.05% once a day for 4-6 weeks can be recommended as primary treatment in phimosis in boys without scarification of the foreskin. The treatment may be repeated as necessary.

Administration, Topical↗

PubMed2002

[Treatment of phimosis with locally applied 0.05% clobetasol propionate. Prospective study with 108 children].

OBJECTIVE: This study was designed to evaluate the efficacy of topical application of corticosteroid cream in the treatment of phimosis in children and to compare the results obtained with those reported in the literature. MATERIALS AND METHODS: In the context of a prospective study conducted between January 1997 and November 2001, 108 children with a mean age of 5.9 years, presenting with true phimosis preventing retraction of the foreskin, were treated by twice-daily application of 0.05% clobetasol propionate cream for 10 days. The results were evaluated at one month and then every six months by a urologist in the outpatients department. A second course of treatment identical to the first was proposed in the case of failure or partial efficacy. RESULTS: 96 children were evaluated with a mean follow-up of 14 months (range: 6 to 24 months). Seventy nine children (82%) are cured after a first course of treatment. In the remaining 17 children, 2 were treated by circumcision and 15 received a second course of treatment resulting in cure in another 9 cases. The final cure rate was therefore 92%. Among the six failures, 4 children were circumcised, corresponding to a total of 6 circumcisions out of this series of 96 cases of phimosis (6%). No local or systemic adverse effects related to steroid therapy were observed and no recurrence of phimosis was observed during the study. CONCLUSION: This study confirms the efficacy and safety of local steroid therapy in the treatment of phimosis in children. Surgical treatment of phimosis should therefore be reserved for failures of medical treatment and has now become much less frequent.

Administration, Topical↗

PubMed1988

The histologic spectrum of prepuces from patients with phimosis.

Histologic examination of the prepuces removed from 78 consecutive patients with phimosis was performed during a 2-year period. In 15 cases (14.2%), the typical changes of lichen sclerosus et atrophicus (LSA) were found. A different, distinct histologic pattern of fibrosis was noticed in six patients (7.7%). Clinically, the two conditions were indistinguishable and presented as severe, nonretractable phimosis. The largest group of the patients (46.2%) had histologically normal prepuces, but clinically they too had severe phimosis. Since phimosis especially in young boys may regress spontaneously, and since on the other hand LSA may evolve into squamous cell carcinoma, we conclude that treatment of phimosis should be planned according to its histologic pattern and not according to its monotonous clinical appearance.

Adolescent↗

PubMed2002

Topical steroid therapy as an alternative to circumcision for phimosis in boys younger than 3 years.

UNLABELLED: PURPOSE Topical steroids are an effective alternative to circumcision for the treatment of phimosis. However, their use has been reported primarily in older boys thought to have "pathological" or secondary phimosis. We report the effectiveness of topical steroids as an alternative to circumcision in infants and young children. MATERIAL AND METHODS: We evaluated 27 boys with phimosis for possible circumcision because of genitourinary anomalies (4), a history of urinary tract infection (11) or both (7), or balanoposthitis (5). Patient age ranged from 1 to 31 months (mean 11.3). In no case could the prepuce be retracted to visualize the meatus. Patients were treated with 0.05% betamethasone cream applied to the distal aspect of the prepuce twice daily for 1 month. RESULTS: Of the boys 20 (74%) had fully retractable foreskins after 1 month of treatment with betamethasone and 5 (18%) had a partial response at 1 month, with the prepuce becoming fully retractable during month 2 of therapy. No adverse side effects were noted. Of the 2 patients in whom treatment failed 1 subsequently underwent circumcision while the parents of the other refused further therapy. CONCLUSIONS: Topical steroids appear to resolve phimosis effectively in boys younger than 3 years. Given proven efficacy in children older than 3 years, topical steroid therapy represents a potential alternative to circumcision regardless of the age of the patient, type of phimosis or relative indication for treatment.

Administration, Topical↗

PubMed1996

Phimosis: is circumcision necessary?

Circumcision has been the traditional treatment for phimosis, but now is not the only management option, the best of which appears to be topical steroid application. Importantly, the literature suggests that phimosis probably is over-diagnosed, indicating that a prospective, randomized controlled study is needed to compare the non-circumcision options. Such a study would require consensus on the diagnostic criteria for phimosis; therefore, a more exacting definition would be needed and is suggested. Despite the non-controlled data on medical treatment of true phimosis, there seems little doubt that surgical intervention is not needed for all male infants with adherence of the foreskin to the glans, a non-retractable foreskin or, indeed, true phimosis.

Administration, Topical↗

PubMed2004

Ballooning of the foreskin and physiological phimosis: is there any objective evidence of obstructed voiding?

OBJECTIVES To determine whether physiological phimosis with or without ballooning of the prepuce is associated with noninvasive urodynamic or radiological evidence of bladder outlet obstruction. PATIENTS AND METHODS From August 2001 to October 2002 all boys with a foreskin problem and referred to one paediatric surgeon were assessed in special clinics. Those with physiological phimosis were recruited for the study and had upper tract and bladder ultrasonography (US), followed by uroflowmetry and US-determined postvoid residual urine volumes (PVR). Data were compared between boys with and with no ballooning of the prepuce. The project was approved by the local research ethics committee and informed consent was obtained from all study participants. RESULTS In all, 54 patients were referred for circumcision; 32 boys with physiological phimosis completed the uroflow and US investigations. Ballooning of the foreskin was present in 18 boys (mean age 6.8 years, range 3-12); 14 had physiological phimosis with no ballooning (mean age 6.5 years, range 4-11). Upper tract US and bladder wall thickness were normal in all boys. The mean maximum urinary flow rate (Q(max)) was not significantly different in boys with ballooning and those without (mean 15.3 mL/s, sd 4.4, range 9-24, vs 15.4, sd 2.9, range 10.7-20, P = 0.96). In addition, all Q(max) values were within the normal range when correlated with voided volume and compared with age-related nomograms. Most boys had flow rate patterns showing a normal bell-shaped curve; a few (9%) had subtle changes in the flow-rate profile, with either a plateau-type curve or slow initial increase in flow and prolonged time to achieve Q(max). The two groups had comparable mean PVRs (3.5 mL, sd 5.1, range 0-18 with ballooning vs 6.1, sd 10.7, range 0-38 without, P = 0.37). Only one patient had a marginally abnormal PVR. CONCLUSIONS Physiological phimosis with or without ballooning of the prepuce is not associated with noninvasive objective measures of obstructed voiding. Minor abnormalities in the flow-rate pattern in this patient group deserve further study.

Child↗

PubMed1997

[Foreskin retraction for phimosis of the newborn].

BACKGROUND: No guideline exists on how to treat boy's phimosis. We examined if retraction of the foreskin of the newborn boy's penis could make true phimosis become false phimosis. METHODS: We taught the mother to retract the foreskin and keep inside the foreskin clean. Exposure degree of glans by retraction of foreskin was defined in 7 grades, 0 (none) approximately III (middle) approximately VI (full). RESULTS: Of the 538 newborn examined, none had full exposure (VI). All of the 372 cases who continued the procedure, including 2 buried penis, gained full exposure (VI). Average time for full exposure according to the first degree of exposure was 2.94 months (0), 1.78 months (III), 1.22 months (V), 2.32 months average, respectively. No serious complications occurred. CONCLUSION: Retraction of the foreskin from the newborn period made all the true phimosis to be false phimosis and operative procedures became unnecessary.

Health Education↗

PubMed1989

Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?

Thirty thousand circumcisions are performed annually in England and 70% of these are upon boys under 15 years of age. In the Mersey Region some 950 boys are circumcised each year for medical indications, the commonest being 'phimosis', which accounts for 87% of cases, of whom almost one-half are under 5 years of age. Regional practice is compared with that of our Unit, where the majority of referrals had developmentally non-retractile foreskin rather than true phimosis, where circumcisions for phimosis and for balanoposthitis occurred in almost equal numbers, and where no example of true phimosis was seen in boys under 5 years of age. It appears that in the Mersey Region many boys are circumcised for development non-retractability of the prepuce rather than for true phimosis and that in consequence some two-thirds of the operations are unnecessary.

Adolescent↗