[Assessment of topical steroid treatment for childhood phimosis: review of the literature]

Abstract

Objectives: Questions concerning nonretractile foreskin are frequently asked by parents in infant consultations. Topical steroid treatment could be a less expensive and less traumatizing alternative to surgery.

Aim: To assess the effectiveness of topical steroid therapy in boys with phimosis.

Methods: Literature review. All randomized controlled trials were selected, using the following research sources: Medline, Cochrane Library, Pascal, Embase, Blackwell Science, Google, Google scholar, SUDOC, international register of trials, and congress abstracts. Unpublished trials were also searched. The trials were analyzed using the ANAES guide from a therapeutic article.

Results: Seven randomized controlled trials (n=714 patients) were in accordance with the inclusion criteria. The patients were between 1 and 12 years old. The treatment lasted for 4-8 weeks. The success rate at the end of the study was higher with the steroid (53.8-95%) than with the placebo (6.25-52%), P<0.05 for 6 randomized control trials.

Discussion: According to the ANAES criteria, the level of scientific evidence is low (gradeC) because of the lack of power in clinical trials and numerous methodological shortcomings and biases, even when examining both randomized control trials and nonrandomized trials. Only a few local side effects were noted.

Conclusion: The use of topical steroids can be recommended in first-intention treatment before surgery for the management of phimosis.