局部类固醇治疗小儿包茎临床疗效分析

目的评价局部类固醇治疗小儿包茎的临床疗效。方法随机选取2001年10月至2003年4月门诊包茎患儿40例，年龄2～14岁，平均8．7岁。其中外口狭窄型15例、粘连型25例，粘连分级Ⅰ级9例、Ⅱ级9例、Ⅲ级7例。给予0．05％倍他米松软膏，早晚各一次涂抹于包皮狭窄开口及粘连处，5d后每次用药时可轻微用力上翻包皮，1个月后门诊随访评价疗效。结果40例患儿中完全治愈26例、好转10例、无效4例，治愈率65％，总有效率90％。其中包皮粘连Ⅰ级治愈率100％、Ⅱ级78％、Ⅲ级29％，总有效率92％，包皮外口狭窄型治愈率为53％，总有效率86％。患儿治疗期间均无不良反应。结论局部类固醇治疗小儿包茎是一种安全、简便、无痛、有效的新方法。     

Conservative treatment of childhood phimosis with topical conjugated equine estrogen ointment

PURPOSE: To assess the application of topical conjugated equine estrogen for the treatment of boys with phimosis. METHODS: Fifteen boys with phimosis were included in the study. Conjugated equine estrogen (Premarin) 0.1% ointment was applied on the prepuce once daily. The treatment was continued until the prepuce was fully retractable. The patient was examined each second week up to a maximum treatment of 8 weeks. Retractability and the appearance of the foreskin were graded before and after treatment. RESULTS: Thirteen of 15 boys (87%) referred with phimosis were successfully treated with conjugated equine estrogen ointment. An adverse effect of gynecomastia was seen in one boy (7%). CONCLUSION: Conjugated equine estrogen ointment application for phimosis may be an alternative to surgery.     

Treatment of phimosis with topical steroids in 194 children

PURPOSE: Topical steroids have been advocated as an effective economical alternative to circumcision in boys with phimosis. We evaluated the effectiveness of topical steroid therapy as primary treatment in 194 patients with phimosis. METHODS: Between January 1996 and November 2000, 228 boys 16 years old or younger were referred for consideration of circumcision. When intervention was determined to be necessary, a 6-week course of topical steroids was used as primary treatment. Efficacy of treatment was evaluated at 3 months from initiation of therapy. RESULTS: Of the 228 patients 15 had such a mild degree of phimosis that no intervention was believed to be necessary, 19 were scheduled directly for circumcision due to cosmetic reasons, parent wishes, or severe phimosis with associated voiding problems and the remaining 194 received topical steroids as primary treatment. Of these 194 patients 25 had coexisting balanitis and 4 had a history of urinary tract infection. Conservative treatment was successful in 87%, 88% and 75% of patients with phimosis alone, coexisting balanitis and history of urinary tract infection, respectively. Overall, circumcision was avoided in 87% of patients treated with topical steroids. CONCLUSION: Topical steroids are becoming the standard conservative measure for treating phimosis. Our study supports this trend, with an overall efficacy of 87%.     

Highly potent and moderately potent topical steroids are effective in treating phimosis: a prospective randomized study

PURPOSE: We report a prospective randomized study comparing the effects of highly potent and moderately potent topical steroids in treating pediatric phimosis. MATERIALS AND METHODS: A total of 70 boys 1 to 12 years old with phimosis were randomly assigned to receive topical application of either betamethasone valerate 0.06% (a highly potent steroid) or clobetasone butyrate 0.05% (a moderately potent steroid). Parents of the boys were instructed to retract the foreskin gently without causing pain, and to apply the topical steroids over the stenotic opening of the prepuce twice daily for 4 weeks, then for another 4 weeks if no improvement was achieved. Retractibility of the prepuce was graded from 0 to 5. Response to treatment was arbitrarily defined as improvement in the retractibility score of more than 2 points. RESULTS: Mean treatment and followup periods were 4.3 and 19.1 weeks, respectively. The response rates in boys treated with betamethasone valerate and clobetasone butyrate were 81.3% and 77.4%, respectively (p = 0.63). Mean retractibility score decreased from 3.9 +/- 1.0 to 1.7 +/- 1.1, and 4.2 +/- 1.0 to 1.9 +/- 1.0 in the betamethasone and clobetasone groups, respectively. Both steroids were effective in all age groups. Pretreatment retractibility score did not affect treatment outcomes. No adverse effect was encountered. CONCLUSIONS: Highly potent and moderately potent topical steroids are of comparable effectiveness in treating phimosis. A less potent steroid may be considered first to decrease the risk of the potential adverse effects.     

包茎和包皮过长合并症的整形外科治疗

目的：探索包茎和包皮过长合并症的分类及其治疗方法。方法：对包茎和包皮过长合并症按照感染、发育不良、损伤、肿瘤等进行分类,根据分类不同,采用整形外科相关的方法予以治疗,并观察其疗效。结果：357例包茎和包皮过长合并症患者,分别利用手术、CO2激光、高频电刀等方法治疗,合并症临床治愈率达98%。结论：包茎和包皮过长合并症患者使用整形外科手术等相关治疗,效果良好。     

婴幼儿包茎及包皮过长治疗进展

包茎和包皮过长是男科的常见病和多发病,可见于大多数男性婴幼儿。在婴幼儿期治疗包茎和包皮过长具有花费少、效益高、安全性高的特点,特别在预防婴幼儿尿路感染,成年后减少浸润性阴茎癌和性传播疾病,提高男性生殖健康等方面都有很大益处。一些国家普遍对新生儿实行包皮环切术,而我国目前新生儿和幼儿包皮环切率很低。本文综述了治疗婴幼儿包茎和包皮过长的手术和非手术方法以及婴幼儿包皮环切对生殖健康的益处,呼吁国人重视婴幼儿包茎和包皮过长的治疗。     

无痛液压扩张法治疗小儿假性包茎的临床应用

目的探讨无痛液压扩张法治疗小儿假性包茎的临床效果。方法自2009年7月至2019年1月应用无痛液压扩张法治疗小儿假性包茎489例。采用利多卡因凝胶充分麻醉包茎腔隙后,以注射器液压注射扩张包皮,于充分扩张后以手法翻开包皮。结果本组中327例患儿通过1次扩张成功翻开包皮;48例通过2次扩张翻开包皮;29例通过3次扩张翻开包皮;总成功率83%。其余85例患者转为手术治疗。术后随访1个月,效果较满意。结论采用无痛液压扩张法治疗小儿假性包茎,效果较明显,疼痛反应小,且家长可陪同治疗,是一种较好的治疗方法,值得临床推广。     

Acquired phimosis after plastibell circumcision: a preventable consequence

INTRODUCTION

The plastibell device is used successfully for religious and cultural circumcisions in the community. The aim of this article is to highlight the recognition and management of iatrogenic phimosis.

METHODS

A retrospective study was performed of outcomes of plastibell circumcision in a community-based circumcision service provided by trained paediatric surgeons. The objective was to assess the complication of slipped plastibell rings and to ascertain the effectiveness of its management.

RESULTS

A total of 5 patients with a slipped plastibell ring were indentified out of 560 plastibell circumcisions. Three patients presented with acquired phimosis. In two patients early diagnosis and management prevented any further complications and a second operation was avoided.

CONCLUSIONS

Plastibell circumcision in the community is safe and effective. Detection of minor bleeding due to a slipped ring is important. Early management can avoid the risk of acquired phimosis due to cicatrix formation and can save parents of undue anxiety.     

Histology and immunohistochemical evaluation of phimotic prepuce: The role of steroid therapy

Phimosis is one of the most frequent andrological diseases in paediatric age. Steroids are useful to treat phimosis. Through a retrospective study of histological and immunohistochemical analysis, we evaluated the effectiveness of topical steroid treatment in patients undergoing circumcision. Cases of patients treated for phimosis were selected during the two-year study period. All patients underwent circumcision and were divided into four groups: groups A (religiously circumcised patients), B (phimotic patients not undergoing steroid treatment), C (phimotic patients who do not respond to cortisone treatment) and D (hypospadic patients undergoing urethroplasty). An histological evaluation of the degree of fibrosis and an immunohistochemical evaluation of collagen IV and tenascin were carried out. Study results demonstrate that the grade of fibrosis is age-related. On histological and immunohistochemical evaluation, fibrosis was found to be lower in patients receiving steroids; higher degrees of fibrosis were found in older patients (p < .05). Different degrees of fibrosis have also been found in hypospadic patients. We can conclude that study results correlated with the clinical history of the patients. The success rate of medical therapy seems to be age-related.     

Psychological trauma of circumcision in the phallic period could be avoided by using topical steroids

OBJECTIVE: The objective of our study was to assess the efficacy of topical steroids in the treatment of phimosis and evaluate patients using the Diagnostic and Statistical Manual-III-Revised (DSM-III-R) test with the aim of eliminating castration anxiety of circumcision in the phallic period. METHODS: One hundred and forty-nine children with phimosis who required circumcision were included the study. The average age of the children was 4.47 years. All children underwent the DSM-III-R test and their parents were questioned. Patients were separated randomly into three groups. Group I comprised 51 children who would undergo circumcision; group II comprised 50 children who would be treated with a topical corticosteroid (0.05% bethamethasone cream) twice daily for 1 month; and group III comprised 48 children who would be treated with a topical placebo cream. On the 5th day of treatment, parents were told to retract the prepuce and were given hygiene routine instructions. Patients were seen immediately after treatment and again 2 months later. RESULTS: In group II, 16 of the 50 children had non-retractable prepuce. Forty-two cases of phimosis were corrected after treatment. Eight patients received further monthly treatment and five benefited from the second course of treatment. In group III, 17 of the 48 patients had non-retractable prepuce and four had satisfactory results. Forty-four patients received placebo treatment for another month and eventually, 40 children underwent circumcision in this group. DSM-III-R test results showed a significant shift to anxiety in the circumcision group. The were no significant differences in the other groups. CONCLUSION: Topical steroids for the treatment of phimosis is a highly effective treatment alternative to surgery. It avoids or delays circumcision and can be practised during the phallic period to decrease castration anxiety. The treatment is suitable for patients from any religious or cultural background.     

209例不同术式环切术治疗包茎和包皮过长

目的评价不同术式环切术治疗包茎及包皮过长的方法和疗效。方法自2001年起,共收治包茎和包皮过长患者209例,包茎85例,包皮过长124例。其中已婚者53例。行剪刀法包皮环切术59例,血管钳法包皮环切术31例,袖套法包皮环切术47例,阴茎根部皮肤环切术72例。结果改良术式(袖套法、根部法)手术时间、术中出血量和术后创口疼痛时间与传统术式(剪刀法、血管钳法)比较差异均有统计学意义(P<0.01)。传统术式发生出血或血肿19例,伤口感染10例,阴茎水肿34例,包皮过长或过短8例;改良术式术后伤口感染2例,阴茎水肿5例,无出血或血肿及包皮过长或过短。总并发症发生率为37.32%,其中传统术式并发症33.97%,改良术式3.35%,对比差异有显著性意义(P<0.01);已婚者性满意度提高23例,其中改良术式18例,差异有统计学意义(P<0.05)。结论严格掌握不同术式的适应证,根据患者情况灵活选择术式可降低并发症发生率,提高婚后性生活质量。     

点阵激光联合外用曲安奈德治疗神经性皮炎的临床效果

目的 探究点阵激光联合外用曲安奈德治疗神经性皮炎的临床效果。方法 选择我院2022年2月- 10月收治的50例神经性皮炎患者为研究对象,按照随机数字表法分为对照组和治疗组,每组25例。对照组 给予曲安奈德注射治疗,治疗组给予点阵激光照射后联合曲安奈德涂抹治疗,比较两组症状评分和临床疗 效。结果 治疗组皮损红斑、水肿/浸润/丘疹、鳞屑、苔藓样变、瘙痒程度评分低于对照组（P ＜0.05）; 治疗组治疗总有效率为96.00%,高于对照组的72.00%（P ＜0.05）。结论 对神经性皮炎患者采用点阵激光 联合外用曲安奈德治疗法能够有效提升治疗效果,缓解症状,值得临床应用。     

新型一次性包皮环切吻合器治疗包皮过长和包茎2O例临床分析

目的：探讨新型一次性包皮环切吻合器治疗包皮过长和包茎的治疗效果。方法：应用一次性包皮环切吻合器,对20例包皮过长或包茎的患者,给予包皮环切术。结果：手术均采用包皮环切吻合器完成。手术时间平均约3～8min。术后未出现切口大片裂开,血肿形成或迟发大量出血。其中2例患者有少量渗血,行加压包扎两天后出血完全停止,1例有钛钉松动伴有约1．5cm切口裂开,予换药包扎5天后切缘对合平整,余下患者3天后拆除纱布无明显水肿、出血。术后1个月复诊,20例患者切口愈合良好,术后阴茎外观美观。结论：新型一次性包皮环切吻合器切割吻合一次完成,微创、手术时间短,患者痛苦小,美观、治疗效果好,值得推广。     

包皮过长和包茎组织中触觉小体观察

目的观察包茎和包皮过长组织中触觉小体差异情况。方法收集21~25岁年龄组包皮标本44例,按包皮解剖形态分为:①包茎组21例;②包皮过长组23例。用免疫组化方法对两组包皮标本中的触觉小体进行染色,在放大100倍的视野下观察和统计两组包皮标本中触觉小体总数以及视野的总数,并用卡方检验对两组间的差异进行统计学分析。结果两组标本中,分别有8个(8/21包茎组)和10个(10/23包皮过长组)标本中未发现触觉小体,其差异无显著性(P=0.717)。包茎组和包皮过长组中触觉小体的密度分别为33.1%和21.1%,差异具显著性(P=0.022)。结论包茎中触觉小体密度较包皮过长明显升高可能是一种生理性代偿机制,而两种包皮组织中触觉小体的消失可能遵循同一规律。     

Treatment of Small Keloids Using Intralesional 5-fluorouracil and Triamcinolone Acetonide versus Intralesional Bleomycin and Triamcinolone Acetonide

BACKGROUND: The aberration of wound healing leads to scar formation in the form of hypertrophic scars and keloids. Various modalities with variable results have been used in the treatment of keloids. OBJECTIVE: We sought to evaluate outcomes in the treatment of small keloids with the combination of intralesional 5-fluorouracil (5-FU) and triamcinolone acetonide versus intralesional bleomycin and triamcinolone acetonide. DESIGN: Sixty clinically diagnosed keloid lesions in 40 patients aged 18 to 60 years were divided equally into Groups A (n=30) and B (n=30). The combination of intralesional 5-FU and triamcinolone acetonide (TAC) was given to Group A and the combination of intralesional bleomycin and triamcinolone acetonide was given to Group B. Treatment was repeated in both groups at three-week intervals until keloid flattening was achieved or a maximum of 10 treatments were completed. Before treatment, the lesions were assessed using the Vancouver Scar Scale and their size was measured using vernier calipers. RESULTS: In Group A, 15 (50%) keloids showed an excellent response, 10 (33.33%) keloids showed a good response, three (10%) keloids showed a fair response, and two (6.66%) keloids showed a poor response. In Group B, 23 (76%) keloids showed an excellent response, three (10%) keloids showed a good response, two (6.66%) keloids showed a fair response, and two (6.66%) keloids showed a poor response. CONCLUSION: Patient response regarding treatment duration, flattening of lesions, improvements in the Vancouver Scar Scale score, and recurrence rates were statistically significant in Group B. A greater improvement in the signs and symptoms of keloids (with respect to cosmetic problems, restriction of movement, and tenderness) was observed in the patients treated with a combination of intralesional bleomycin and triamcinolone acetonide compared to those treated with a combination of intralesional 5-FU and triamcinolone acetonide.     

Local steroid therapy of adnexal strawberry hemangioma in infants —long-term follow-up

Summary Two patients with orbital or ocular adnexal neonatal hemangiomas were treated with intralesional injection of triamcinolone acetonide. Injection of steroids was started at 2 mg/kg twice a week. The doses of this drug were decreased gradually over a four week period. A dramatic reduction of the lesion was evident without a rebound phenomenon: however growth delay continued for only three months after therapy. No exact study of the storage of this compound in the tissue has been reported. The storage of triamcinolone acetonide was investigated for a period of up to 35 days in the tissue of rabbit backs. The 0 level of the residue was suggested to occur at about 60 days after injection of triamcinolone acetonide. In the two infants of the experimental study with strawberry-type nervus, the storage in the tissue of hemangioma was much higher than in rabbits. These results were comparable to the duration of the growth delay.     

包皮过长或包茎患者的性功能状况与心理状态关系的研究

目的:通过分析泌尿男科门诊包皮过长或包茎患者的性功能状况与心理状态,探讨性功能障碍与心理异常之间的相互关系。方法:随机选择包皮过长或包茎患者216例,问卷调查患者的一般情况、中国早泄患者性功能评价表、国际勃起功能指数问卷、症状自评量表。调查研究患者的早泄与勃起功能障碍情况,心理状态抑郁、焦虑等症状,统计其发生率,分析各症状间的相互关系。85例健康男性志愿者为正常对照组。结果:病例组的症状自评量表总分、躯体化因子分、强迫症状因子分、抑郁因子分、焦虑因子分、其他因子分明显高于正常对照组(P<0.05)。相关分析显示:早泄评分与症状自评量表总分、躯体化因子分、强迫症状因子分、人际关系敏感因子分、抑郁因子分、焦虑因子分及其他因子分有显著相关性。勃起功能障碍评分与症状自评量表总分及各项因子分无相关性。结论:泌尿男科门诊包皮过长或包茎患者的心理健康水平较差,早泄与心理状态存在相互影响。