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포경의 1차 치료로서 국소 스테로이드 도포의 결과: 스테로이드제 강도에 따른 비교
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경북대학교 의과대학 비뇨의학교실¹
경북대병원 비뇨의학과²
칠곡경북대병원 비뇨의학과³ |
| 장세원², 이승윤², 오정석², 권순오², 김상원³, 정재욱³, 하윤석¹·³, 김범수¹·², 유은상¹·², 이준녕¹·³ |
Background and Objectives : Phimosis is a condition in which the foreskin of the penis cannot be retracted over the glans. Although the first line treatment of phimosis was circumcision before 1990’s, topical steroid therapy has recently been proposed as an alternative to surgery. However, the optimal topical agent related to potency of steroids has not yet to be identified. Therefore, we evaluated the outcomes of topical steroids therapy according to potency as the first-line treatment for boys with symptomatic phimosis.
Materials and Methods : From April 2017 to March 2019, we retrospectively reviewed 45 boys with severe phimosis (Kikiros retractability grade of 4 or 5) who had phimosis-related complications such as balanoposthitis, ballooning of the prepuce, a history of urinary tract infection, or lower urinary tract dysfunction. During the first year of the study period, medium potency topical steroid (Methylprednisolone aceponate, Advantan®) was applied in 24 boys. Lowest potency topical steroid (Hydrocortisone probutate, Bandel®) was used in 21 boys in the subsequent period. Topical steroids were used for 4-8 weeks in all patients. Success of therapy was determined by two conditions at 8 weeks after therapy: reaching Kikiros grade 3 or less and disappearance of symptom.
Results: Of the total 45 boys, success was observed in 35 patients (77.8%). Recurrence of phimosis with clinical complications was confirmed in three out of 35 patients with initial success (8.6%) during the follow-up period of 15.5 months. All recurred boys showed remission after additional topical steroid therapy. Success rate of medium potency steroid group was higher than that of lowest potency steroid group (91.7% and 61.9% respectively, p = 0.029). There were no significant differences in preoperative patients’ characteristics including age, balanoposthitis, ballooning of the prepuce, a history of urinary tract infection, and lower urinary tract dysfunction between the two groups. Side effects associated with the application of topical steroids were not observed in all children.
Conclusion: The application of topical steroids is an effective and safe procedure as the first-line treatment in symptomatic boys with severe phimosis. In addition, potency of topical steroids for the treatment of phimosis is considered as a factor affecting success rate.
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keywords : Phimosis; Steroids; Treatment outcome |
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