Topical Steroids, an alternative to circumcision for treatment of Phimosis at the University Teaching Hospital,Lusaka
Nzayisenga, Baptiste J.
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A prospective study to evaluate the effectiveness of topical steroid as a treatment option for phimosis and its economical benefits compared to circumcision has been conducted from December 2003 to February 2005 at The University Teaching Hospital. A total of 365 patients with phimosis were referred to the Paediatric Surgical Clinic from December 2003 to December 2004. For the recruitment period of first 8 months, 262 patients were seen. Of these 43 had physiological phimosis and parents understood that there was no need for any intervention, 6 were scheduled for circumcision (5 of them due to parents wish and the other one had a very severe phimosis associated with urine retention and recurrent infection), 31 were recruited in another study and all these were excluded. The remaining 182 participated in our study. Two groups were compared: Group 1 of 125 patients who opted for conservative management by a topical steroid namely betamethasone cream of 0.1 %. Of these 125 patients, 85 (68.0%) received topical steroid therapy as primary treatment and they were termed" new cases", while 40 (32.0%) were "recurrent" phimosis some weeks after dilatation before the commencement of this study. Group 2 of 57 (31.3%) were the patients who, at presentation, had dilatation of the phimotic prepuce as means of treatment. This group acted as a control. The age ranged between 1 to 13 years with an average of 23.37 months (median of 16 months); both groups included.The follow up was of 6 months from the commencement of the treatment for both groups. Of all patients, 141 (77.5%) successfiilly completed the follow up per-iod, 92 (65.2%) in Groupl and 49 (34.8%) in Group2. In Groupl, 80 (86.9%) had a successfiil outcome and 12 (13.1%) failed to achieve frill foreskin retraction while in Group 2 only 17(34.0%) had a good outcome, 32 (66.6%) failed to maintain the retraction after dilatation and had recurrences. One child (0.01%) of Group 1 developed acute severe paraphimosis that he required general anaesthesia for reduction. The average nvimber of betamethasone tube cream (15gr) used, was 1.7 while the average price for each tube was K4000.00.The overall economical saving was estimated at about 90% compared to the cost of the circumcision. The study shows that topical steroid, betamethasone 0.1%, is efficient, safe and cost effective in treating phimosis. We highly recommend this conservative method to become the standard and initial measure for the treatment of phimosis particularly in upcountry hospitals and health centers.
- Medicine