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Meta-Analysis
. 2014 Sep 2;2014(9):CD008973.
doi: 10.1002/14651858.CD008973.pub2.

Topical corticosteroids for treating phimosis in boys

Gladys Moreno  1 , Javiera Corbalán, Blanca Peñaloza, Tomas Pantoja
Affiliations
Meta-Analysis

Topical corticosteroids for treating phimosis in boys

Gladys Moreno et al. Cochrane Database Syst Rev. .

Update in

  • Topical corticosteroids for treating phimosis in boys.
    Moreno G, Ramirez C, Corbalán J, Peñaloza B, Morel Marambio M, Pantoja T. Moreno G, et al. Cochrane Database Syst Rev. 2024 Jan 25;1(1):CD008973. doi: 10.1002/14651858.CD008973.pub3. Cochrane Database Syst Rev. 2024. PMID: 38269441 Free PMC article.

Abstract

Background: Until recently, phimosis has been treated surgically by circumcision or prepuceplasty; however, recent reports of non-invasive treatment using topical corticosteroids applied for four to eight weeks have been favourable. The efficacy and safety of topical corticosteroids for treating phimosis in boys has not been previously systematically reviewed.

Objectives: We aimed to 1) compare the effectiveness of the use of topical corticosteroid ointment applied to the distal stenotic portion of the prepuce in the resolution of phimosis in boys compared with the use of placebo or no treatment, and 2) determine the rate of partial resolution (improvement) of phimosis, rate of re-stenosis after initial resolution or improvement of phimosis, and the rate of adverse events of topical corticosteroid treatment in boys with phimosis.

Search methods: We searched the Cochrane Renal Group's Specialised Register through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Date of last search: 16 June 2014.

Selection criteria: We included all randomised controlled trials (RCTs) that compared use of any topical corticosteroid ointment with placebo ointment or no treatment for boys with phimosis.

Data collection and analysis: Two authors independently assessed titles, abstracts and the full-text of eligible studies, extracted data relating to the review's primary and secondary outcomes, and assessed studies' risk of bias. Statistical analyses were performed using the random-effects model and results were expressed as risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). We contacted authors of primary articles asking for details of study design and specific outcome data.

Main results: We included 12 studies that enrolled 1395 boys in this review. We found that both types of corticosteroids investigated and treatment duration varied among studies.Compared with placebo, corticosteroids significantly increased complete or partial clinical resolution of phimosis (12 studies, 1395 participants: RR 2.45, 95% CI 1.84 to 3.26). Our analysis of studies that compared different types of corticosteroids found that these therapies also significantly increased complete clinical resolution of phimosis (8 studies, 858 participants: RR 3.42, 95% CI 2.08 to 5.62). Although nine studies (978 participants) reported that assessment of adverse effects were planned in the study design, these outcomes were not reported.Overall, we found that inadequate reporting made assessing risk of bias challenging in many of the included studies.Selection bias, performance and detection bias was unclear in the majority of the included studies: two studies had adequate sequence generation, none reported allocation concealment; two studies had adequate blinding of participants and personnel and one had high risk of bias; one study blinded outcome assessors. Attrition bias was low in 8/12 studies and reporting bias was unclear in 11 studies and high in one study.

Authors' conclusions: Topical corticosteroids offer an effective alternative for treating phimosis in boys. Although sub optimal reporting among the included studies meant that the size of the effect remains uncertain, corticosteroids appear to be a safe, less invasive first-line treatment option before undertaking surgery to correct phimosis in boys.

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Conflict of interest statement

  1. Gladys Moreno: none known

  2. Javiera Corbalán: none known

  3. Blanca Peñaloza: "I have received financing support from FONIS, a Chilean government grant, to develop my contribution to this review"

  4. Tomas Pantoja: none known

Figures

1
1
Study flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias (methodological quality) item presented as percentages across all included studies
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
1.1
1.1. Analysis
Comparison 1: Topical corticosteroids versus placebo, Outcome 1: Resolution of phimosis (complete or partial)
1.2
1.2. Analysis
Comparison 1: Topical corticosteroids versus placebo, Outcome 2: Complete resolution of phimosis
1.3
1.3. Analysis
Comparison 1: Topical corticosteroids versus placebo, Outcome 3: Re‐stenosis
1.4
1.4. Analysis
Comparison 1: Topical corticosteroids versus placebo, Outcome 4: Adverse effects (any)
See this image and copyright information in PMC

References

References to studies included in this review

Balamtekin 2006 {published data only (unpublished sought but not used)}
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References to studies excluded from this review

Ceballos‐Gonzalez 2006 {published data only}
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References to ongoing studies

NCT01108198 {published data only}
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