Topical steroid therapy as an alternative to circumcision for phimosis in boys younger than 3 years

Purpose: Topical steroids are an effective alternative to circumcision for the treatment of phimosis. However, their use has been reported primarily in older boys thought to have "pathological" or secondary phimosis. We report the effectiveness of topical steroids as an alternative to circumcision in infants and young children. Materials and Methods: We evaluated 27 boys with phimosis for possible circumcision because of genitourinary anomalies (4), a history of urinary tract infection (11) or both (7), or balanoposthitis (5). Patient age ranged from 1 to 31 months (mean 11.3). In no case could the prepuce be retracted to visualize the meatus. Patients were treated with 0.05% betamethasone cream applied to the distal aspect of the prepuce twice daily for 1 month. Results: Of the boys 20 (74%) had fully retractable foreskins after 1 month of treatment with betamethasone and 5 (18%) had a partial response at 1 month, with the prepuce becoming fully retractable during month 2 of therapy. No adverse side effects were noted. Of the 2 patients in whom treatment failed 1 subsequently underwent circumcision while the parents of the other refused further therapy. Conclusions: Topical steroids appear to resolve phimosis effectively in boys younger than 3 years. Given proven efficacy in children older than 3 years, topical steroid therapy represents a potential alternative to circumcision regardless of the age of the patient, type of phimosis or relative indication for treatment.