Osman AKYÜZ, Mehmet Nuri BODAKÇI, Zeynep TATAR, Müslüm ERGÜN, Soner ÇOBAN, Haydar Kamil ÇAM

Termokoterle Yapılan Sünnet Sonrası Gelişen Fimozisin Tedavisinde Topikal Steroid Kremin Etkinliği

Amaç: Termokoter cihazı, hızlı ve güvenli sünnet için lokal anestezi altında yapılan sünnetlerde ülkemizde yaygın olarak kullanılmaktadır. Termokoterle sünnet sonrası gelişebilecek komplikasyonlardan bir tanesi de patolojik fimozdur. Ancak literatürde bu komplikasyonun medikal tedavisi ile ilgili çalışma yoktur. Termokoterle sünnet sonrası gelişen patolojik fimozisin tedavisinde topikal kortikosteroid uygulamasının etkinliğini araştırmayı amaçladık. Gereç ve Yöntemler: 2009 ile 2018 yılları arasında, hastanemizde uygulanan sünnetler sonrası sekonder fimozis gelişen, yaşları 1-8 arasında değişen 68 hastanın verileri bilgisayardan retrospektif incelendi. Termokoter ve bistüri kullanılarak yapılan sünnetlerden sonra gelişen fimozis vakaları iki ayrı gruba ayrılarak topikal steroid tedavisinin etkinliği değerlendirildi. Bulgular: Termokoterle sünnet sonrası grade 5 fimozis gelişen 32 vaka da steroid tedavisine hiçbir yanıt alınamadı. Grade 4 fimozis gelişen gelişen 16 vakanın üç tanesinde kısmi yanıt alınsa da, bu 48 vakanın tamamına cerrahi düzeltme yapıldı. Bistüri grubunda ise grade 5 fimozis gelişen dört vakada da steroide yanıt alınamazken, grade 4 fimozis gelişen sekiz vakanın dört (%50) tanesinde ve grade 3 fimozis gelişen sekiz vakanın altı (%75) tanesinde steroide yanıt alınarak full retraksiyon sağlandı. Bu grupta toplam on vakaya cerrahi müdahale yapıldı. Sonuç: Sünnet sonrası gelişen patolojik fimozis durumlarında da topikal steroid kremler kısmen fayda sağlayabilir. Ancak termokoter kullanımı sonrası gelişen yüksek dereceli fimozis vakalarında etkinlik gösterememektedirler.

Anahtar Kelimeler:

Koter, sünnet, fimozis, topikal steorid

The Effectiveness of Topical Steroid Cream in the Management of Phimosis Developed Following Circumcision Performed With Thermocautery

Objective: In our country, thermocautery device is used extensively for circumcision performed under local anesthesia for fast and safe circumcision. One of the complications that may occur after circumcision with thermocautery is pathological phimosis. However, there aren’t studies in the literature regarding the medical treatment of pathological phimosis after circumcision with thermocautery. We aimed to investigate the effectiveness of topical corticosteroid application in the treatment of pathological phimosis developed after circumcision with thermocautery. Material&Methods: Data of 68 patients (aged: 1-8 years) who developed phimosis secondary to circumcisions performed by one surgeon between the years 2009 and 2018 were analysed retrospectively from a computerised database. Cases of phimosis developed after circumcisions performed using thermocautery and scalpel were analysed in two separate groups, and the effectiveness of topical steroid treatment was evaluated. Results: In the thermocautery group, 32 patients who developed Grade 5 phimosis didn’t respond to steroid therapy, while only three of 16 (18.75%) cases with Grade 4 phimosis responded partially to topical steroid treatment. All these 48 cases were treated with surgery. In the scalpel group, no therapeutic response was elicited in four cases who developed Grade 5 phimosis. However, four out of eight (50%) patients with Grade 4 and six out of eight (75%) patients with Grade 3 phimosis responded to steroid therapy, and full retraction of the foreskin was achieved. In the scalpel group, ten cases underwent surgical revision. Conclusion: Topical steroid creams may be partially beneficial in cases of pathological phimosis after circumcision. However, they do not show efficacy in cases of high-grade phimosis after thermocautery use.

Keywords:

Cautery, circumcision, phimosis, topical steorid,

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