Termokoterle yapılan sünnet sonrası gelişen fimozisin tedavisinde topikal steroid kremlerin etkinliği var mı?

AMAÇ: Termokoter cihazı hızlı ve güvenli sünnet için lokal aneste - zi altında yapılan sünnetlerde çok yaygın olarak kullanılmaktadır. Termokoterle yapılan sünnetlerden sonra gelişebilecek komplikasyonlar- dan birisi de patolojik fimozisdir. Bu komplikasyonun tedavisi genellikle cerrahi revizyondur. Medikal tedavisi ile ilgili litaretürde çok az çalışma bulunmaktadır. Bu çalışmamızda termokoterle sünnet sonrası gelişen patolojik fimozisin tedavisinde topikal kortikosteroid uygulanmasının etkinliğini araştırmayı amaçladık. GEREÇ ve YÖNTEMLER: 2011–2021 yılları arasında hastanemizde sün- net sonrası patolojik fimozis komplikasyonu gelişen, yaşları 1–9 arasında değişen, 54 hastanın verileri rektospektif olarak incelendi. Termokoter kullanılarak yapılan sünnetlerden sonra gelişen fimozis vakalarında topi- kal kortikosteroid uygulanmasının etkinliğini değerlendirildi. BULGULAR: Termokoterle sünnet sonrası grade 5 fimozis gelişen 38 va- kada steroid tedavisine yanıt alınamadı. Grade 4 fimozis gelişen sekiz hastanın altısında steroid tedavisine yanıt alınamadı. Iki vakada kısmi yanıt alınıp grade 3 seviyesine gerilemesine rağmen tam iyileşme sağla - namayıp 2–3 hafta içinde tekrardan grade 4 fimozis gelişti. Tüm hastala- ra oldukça güçlü steroid olan %0,05 klobetazol propiyonat (dermovate %0,05 50 gr, Türkiye) 6–8 hafta boyunca sabah akşam uygulandı ve hiçbir yanıt alınamayan 46 vakanın hepsine sünnet revizyonu yapıldı. Sekiz vakada ise hasta yakınları topikal kortikosteroid uygulanması ka - bul etmedi ve sünnet revizyonu yapıldı. SONUÇ: Sonuç olarak termokoterle sünnet sonrası gelişen yüksek de - receli patolojik fimozis gelişen vakalarda topikal steroid kremler etkili bulunmamıştır.

Do topical steroid creams have efficiency on the treatment of phimosis evolving after circumcision implemented with thermocautery?

OBJECTIVE: Thermocautery device is commonly used in circumcisions implemented under local an anaesthesia for a quick and safe circumcision. One of the complications that might evolve after circumcision implemented with thermocautery is pathological phimosis. Treatment of this complication is generally surgical revision. There are very few studies in the literature about it’s medical treatment. In this study, we aimed to search the efficiency of topical corticosteroid application in the the treatment of pathological phimosis evolving after circumcision implemented with thermocautery. MATERIAL and METHODS: Datas of 54 patients aged 1–9 who evolved pathological phimosis complication after circumcision in our hospital between 2011–2021 were examined retrospectively. Efficiency of topical corticosteroid application in the treatment of pathological phimosis evolving after circumcision implemented with thermocautery was evaluated. RESULTS: In 38 cases which grade 5 phimosis evolved after surgery there was no response to steroid treatment. In 6 of the 8 patients who evolved grade 4 phimosis there was no response to steroid treatment. Although there was partial response and regression to grade 3 in two patients, full recovery was not achieved and grade 4 phimosis reevolved in 2–3 weeks. 0.05% clobetasol propionate a highly strong steroid (Dermovate 0.05% 50 gr, Turkey) for 6–8 weeks morning and evening was implemented to all of the patients and circumcision revision was made in all 46 patients with no response. In 8 cases patient’s relatives did not accept topical corticosteroid and circumcision revision was made. CONCLUSION: As a result, topical steroid is not found to be effective in the treatment of phimosis evolving after circumcision implemented with thermocautery.

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  • 1. Moreno G, Corbalán J, Peñaloza B, Pantoja T. Topical corticosteroids for treating phimosis in boys. Cochrane Database Syst Rev 2014;9:CD008973. [CrossRef]
  • 2. Tekgul S, Dogan HS, Erdem E, Hoebeke P, Koèvara R, Nijman JM, et al. Guidelines on paediatric urology. Pediatric Urology. 2015. https://d56bochluxqnz.cloudfront.net/documents/EAU Pocket-Paediatric-Urology-2015.pdf
  • 3. Akyüz O, Bodakçi MN, Tefekli AH. Thermal cautery-assisted circumcision and principles of its use to decrease complication rates. J Pediatr Urol. 2019;15:186.e1–8. [CrossRef]
  • 4. Dunsmuir WD, Gordon EM. The history of circumcision. BJU Int. 1999;83 Suppl 1:1–12. [CrossRef]
  • 5. Kikiros CS, Beasley SW, Woodward AA. The response of phimosis to local steroid application. Pediatr Surg Int. 1993;8:329–32. [CrossRef]
  • 6. Krill AJ, Palmer LS, Palmer JS. Complications of circumcision. ScientificWorldJournal. 2011;11:2458–68. [CrossRef]
  • 7. Balkan E, Kılıç N. Sünnet ve komplikasyonları. Güncel Pediatri. 2005;2(1):22–3. https://dergipark.org.tr/tr/download/article file/911677
  • 8. Shahid SK. Phimosis in children. ISRN Urol. 2012;4:32–9. [CrossRef]
  • 9. Findling JW, Doppman JL. Biochemical and radiologic diagnosis of Cushing’s syndrome. Endocrinol Metab Clin North Am. 1994;23:511–37. [CrossRef]
  • 10. Ashfield JE, Nickel KR, Siemens DR, MacNeily AE, Nickel JC. Treatment of phimosis with topical steroids in 194 children. J Urol. 2003;169:1106–8. [CrossRef]
  • 11. Kuehhas FE, Miernik A, Sevcenco S, Tosev G, Weibl P, Schoenthaler M, Lassmann J. Predictive power of objectivation of phimosis grade on outcomes of topical 0.1% betamethasone treatment of phimosis. Urology. 2012;80:412–16. [CrossRef]
  • 12. Esposito C, Centonze A, Alicchio F, Savanelli A, Settimi A. Topical steroid application versus circumcision in pediatric patients with phimosis: a prospective randomized placebo controlled clinical trial. World J Urol. 2008;26:187–90. [CrossRef]
  • 13. Lee CH. Lee SD. Effect of topical steroid (0.05% clobetasol propionate) treatment in children with severe phimosis. Korean J Urol. 2013;54:624–30. [CrossRef]
  • 14. Kiss A, Csontai A, Pirót L, Nyirády P, Merksz M, Király L. The response of balanitis xerotica obliterans to local steroid application compared with placebo in children. J Urol. 2001;165:219–20. [CrossRef]
  • 15. Makhija D, Shah H, Tiwari C, Dwiwedi P, Gandhi S. Outcome of topical steroid application in children with non-retractile prepuce. Dev Period Med. 2018;22:71–4. [CrossRef]
  • 16. Nascimento FJ, Pereira RF, Silva 2nd JL, Tavares A, Pompeo AC. Topical betamethasone and hyaluronidase in the treatment of phimosis in boys: a double-blind, randomized, placebo controlled trial. Int Braz J Urol. 2011;37:314–9. [CrossRef]
  • 17. Zampieri N, Corroppolo M, Camoglio FS, Giacomello L, Ottolenghi A. Phimosis: stretching methods with or without application of topical steroids? J Pediatr. 2005;147:705–6. [CrossRef]
  • 18. Alpert SA, Ching CB, DaJusta DG, McLeod DJ, Fuchs ME, Jayanthi VR. Combination treatment for cicatrix after neonatal circumcision: an office based solution to a challenging problem. J Pediatr Urol. 2018;14:471–5. [CrossRef]
  • 19. Abdulwahab-Ahmed A, Mungadi IA. Techniques of male circumcision. J Surg Tech Case Rep. 2013;5:1–7. [CrossRef]
  • 20. Favorito LA, Balassiano CM, Rosado JP, Cardoso LEM, Costa WS, Sampaio FJB. Structural analysis of the phimotic prepuce in patients with failed topical treatment compared with untreated phimosis. Int Braz J Urol. 2012;38:802–8. [CrossRef]