> # Re: to the beta group

> Written by RS at 06 Feb 2000 06:57:03:

> As an answer to: Re: Kenalog as a cure for Phimosis ? written by Nick at 05 Feb 2000 01:34:32:

> Roxanne,
> If kenalog worked so quickly the first time why do you prefer beta05 ?

> (also to repeat Bob`s qurestion ,,, what is kenalog? steroid, cortisone? it reminds me of breakfast cereals at the moment) second question ... what does steroid and cortisone actually do .. what are they? ... chemicals ... simple explanation please I only got 1% in my chemistry mock "O" level ...

> Roxanne + Nick:
> >>The only down side is that the phimosis will recurr without regular continued retraction (a problem we encountered with my son who was only 8 when we used it, but certainly not a problem for any older male).
> >
> >no it isnt. I dont know a guy older than 14 who doesnt at least mastrabate. But you dont even need to do that. Just retract it when you pee.

> even the studies say stretching is necessary, if you could slow down this wonderful burst of youthful energy and describe your experience in detail it may be more persuasive to some of us who are slow in understanding ...

> >>Sometimes no amount of stretching will work (I have heard from quite a few men with this problem).
> >
> >it certainly DID NOT work for me. ....

> So Nick you`d tried stretching ... excuse me but I must ask did you use a competent method ... following Beauge, (and naturally my stretching page) eg. did`n`t it work even in the shower`? (note its nothing against your method, but I wanna get the facts as near as possible accurate ...)

> >>The dorsal slit may prove to be necessary at times, but why do it without trying this more conservative method first. It has a 90% success rate by the way.
> >
> >yes it does, but a lot of doctors dont know about it and insist circ is the only way.

> hummm where does the 90% come from ?? ... look, I`d be very pleased if it helped even 10% of the cases which wouldn`t have stretched otherwise ...

> still I`m much more comfortable with a bit of anti-circ. extremism than the pro circ maniacs, ... just noticed someone on the list who seems to want to give babies partial circs. ... and there is a good friend of mine who would routinely dorsal slit babies (out of the best intentions, however his rational mind seems healthy enough to control his emotional drives) ,,, and here we have the routine beta methasone group ...

> good luck

> I enclose 3 extracts from medical studies .... at a brief read all the studies are on kids and stretchability rates differ considerably with children, at puberty and as adult --- big problem is that retraction was only measurable in the flaccid state --- very interesting is that no adhesions were found after this treatment leads me to wonder if steroids applied to outer foreskin could "heat up" and dissolve the epithelium (word used by Campbell for "infant adhesions" so I`m entitled to follow) ... the other good point on beta .05 is ... it seems there is no known bad side effect ...

> there are many studies in the anti circ libraries saying how phimosis is overdiagnosed yet here we have that the kids defined as

> "pathological, non-retractable foreskins" and
> "Successful treatment depends upon the presence of a normal, supple foreskin at the outset,"

> Dewan is the only one who defines phimosis, and he does a comparison of a number of previous studies - without actually getting his fingers messy himself ..- so no-one has actually studied the effectiveness of beta05 on phimosis ... these studies are all very recent we could be hopeful that Dewan`s conclusion-summary be followed up ...

> Robin

> --------------------------------------------------------------------------------

> TI: The conservative treatment of phimosis in boys.
> AU: Golubovic-Z; Milanovic-D; Vukadinovic-V; Rakic-I; Perovic-S
> AD: Department of Plastic and Reconstructive Surgery, University Children's Hospital, Belgrade, Yogoslavia.
> SO: Br-J-Urol. 1996 Nov; 78(5): 786-8
> ISSN: 0007-1331
> PY: 1996

> AB: OBJECTIVE: To further test the application of topical steroids in boys referred to a paediatric surgical practice with pathological, non-retractable foreskins diagnosed as phimosis. PATIENTS AND METHODS: This prospective study comprised two groups of 20 boys each (mean age 4.1 years, range 3-6) diagnosed as having phimosis; twice daily, a topical steroid (0.05% betamethasone cream) was applied on the narrowed preputial skin in the first group and a neutral cream (Vaseline) in the second (control) group. Patients were treated for 4 weeks and the retractability of the foreskin and any side-effects assessed. RESULTS: Good retraction of the foreskin was achieved in 19 patients treated with betamethasone cream and the response was unsatisfactory in 16 patients from the control group; these 16 boys and one 6-year-old boy treated with betamethasone were circumsized. There were no side-effects or problems after the application of either cream. CONCLUSION: Treatment with 0.05% betamethasone cream is a simple and safe method for the treatment of phimosis in boys older than 3 years. An early operation is necessary in cases of genuine phimosis when 1 month of treatment with topical steroids has failed. We strongly support the saying, "The fortunate foreskin of an infant boy will usually be left well alone by everyone but its owner'.

> TI: The treatment of childhood phimosis with topical steroid [see comments] [published erratum appears in Aust
> N Z J Surg 1995 Sep;65(9):698]
> CM: Comment in: Aust N Z J Surg 1994 Dec;64(12):861. Comment in: Aust N Z J Surg 1995 Jan;65(1):57-8
> AU: Wright-JE
> AD: University of Newcastle Medical School, New South Wales, Australia.
> SO: Aust-N-Z-J-Surg. 1994 May; 64(5): 327-8

> AB: A prospective study of the efficacy of topical steroid in the treatment of childhood phimosis is reported. Boys referred to a paediatric surgical practice with pathological non-retractable foreskins were treated for at least 1 month with topical beta methasone cream. One hundred and thirty-nine patients were treated and 111 completed the study. A satisfactory result, defined as foreskin retractability appropriate for the boys' age, was achieved in 80% of patients. In 10% the response was inadequate at the end of the study period, but these boys were still under treatment or surveillance because their parents declined circumcision. In 10%, circumcision was performed because of failure of treatment. In six patients this was due to balanitis xerotica obliterans (lichen sclerosis et atrophicus) which does not respond to conservative treatment. Successful treatment depends upon the presence of a normal, supple foreskin at the outset, and on parental compliance.

> Dewan PA, Tieu HC, Chieng BS

> Phimosis: is circumcision necessary?

> Urology Unit, Women's and Children's Hospital,
> and the Departments of Surgery and Paediatrics,
> University of Adelaide, Adelaide, Australia.

> J Paediatr Child Health 1996 Aug;32(4):285-9

> Astract:

> 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.

> ... circumcision is the oldest and most performed
> surgical procedure in the world.

> The most common stated medical indication for
> circumcision is phimosis, however, the definition
> of this condition is obscure in most publications.

> Defining Phimosis

> Oster found that the prepuce is retractable in ...
> 99% at 17 years of age. (My Note: one of the
> repeated "misreadings" of Oster:)

> Little is known or written about the aetology of
> true phimosis, despite the supposed frequency
> varying from 4 to 10%.

> In his text book in 1948 Winsbery-White defined
> phimosis as the congenital or acquired narrowing
> of the preputial opening, characterised by a
> non-retractable foreskin without adherence,
> which can lead to retention of secretions ..
> irritation .. balanitis .. interference with
> micturition ... pressure on the bladder, ureters
> and kidneys. (10)

> A more precise and practical guide to the
> difference between a non-retractable and a
> phimotic foreskin is as follows, when the normal
> but non-retractable infant foreskin is examined,
> attempted gentle retraction results in the distal
> part of the foreskin pouting, and the narrow
> portion is proximal to the tip of the prepuce (Fig
> 1). Forced retraction of such a foreskin can result
> in splitting as is well demonstrated in the figures
> presented by Stenram et al. In contrast true
> phimosis produces a cone-shaped foreskin
> during the same gentle retraction manoeuvre,
> with a fibrotic, circular band that forms the most
> distal and narrowest part of the prepuce (Fig 2).

> Confusion about the definition of true phimosis
> is highlighted by the study of Griffiths and
> Frank, who found that of 128 boys with a
> medical reason for referral to a paediatric
> urologist for circumcision, only 30 had true
> phimosis (although they did not give an exacting
> definition). (12) They suggested that ballooning
> and non-retracability is often over-interpreted, in
> some cases, the referring practitioner may have
> used the term "phimosis" to facilitate referral,
> thus further confusing the debate on the
> appropriate management of phimosis.

> Techniques of Phimosis Management

> Non-operative

> .... Steroid cream is a painless, less complicated
> and mor economical alternative to circumcision
> for the treatment of phimosis. Wright had a
> success rate of 80% (89 of 111 boys) using a
> 0.05% betamethasone. Kikiros et al. reported an
> improvement in 33 of 42 boys (78%) with
> 0.05% betamethasone, and in 18 of 21 boys
> (86%) with hydrocortisone, but they considered
> that the betamethasone worked more quickly.
> Another steroid cream, 0.05% clobetasol
> propionate, has also been used successfully by
> Jorgersen and Svensson. ........

> ..... Observed recurrence of phimosis after
> topical steroid treatment ... makes it important
> to commence retraction of the foreskin a number
> of times each day, once the phimosis has
> resolved.

> Summary

> ... From the published results thus far 0.05%
> betamethasone appears to be more effective than
> 1% hydrocortisone. It would appear that regular
> retraction of the foreskin is necessary after initial
> success has been achieved ... However, a
> double-bind randomized control study of
> different steroids and placebo is needed to assess
> the relative effectiveness of each of the steroid
> options. Long-term follow up is needed to
> assess the recurrence risk, ...

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