丙酸氯倍他索乳膏治疗小儿包茎的临床应用(附237例报告)

目的:探讨0.02%丙酸氯倍他索乳膏治疗小儿包茎的临床疗效。方法:选取2012年6月至2015年12月门诊包茎患儿237例,年龄2~14岁,平均8.6岁。按照包茎程度分为5组,分别给予0.02%丙酸氯倍他索乳膏,早晚各1次涂抹于包皮狭窄开口及粘连处,每次用药时轻微用力上翻包皮,每周门诊随访评价疗效,疗程最长8周。结果:失访4例,共有233例患儿获得随访。181例患儿完全治愈,包皮外口狭窄环消失,包皮粘连处松解,可自由翻转以显露阴茎头,治愈率为77.68%;28例(12.01%)患儿有效,狭窄环部分松解可显露部分阴茎头,尚不足自由翻转显露阴茎头;无效患儿24例(10.30%),包皮外口狭窄仍不能上翻显露阴茎头。总有效率为89.70%,治疗过程中无明显不良反应发生。结论:0.02%丙酸氯倍他索乳膏治疗小儿包茎是一种安全、有效、无痛、经济的方法。     

医用透明质酸钠预防小儿包茎环套术后粘连的评价

目的：了解小儿包茎术后包皮粘连的发生及透明质酸预防粘连的效果。方法：2008年12月～2009年1月门诊小儿包茎包皮环套术90例，随机分A、B、C三组，术中分别局部用1％透明质酸、局部用红霉素、空白对照。随访2个月，观察冠状沟处粘连情况。结果：A、B、C三组术中无粘连率分别为10％、6％、10％。粘连面积50％以上三组分别为43％、53％、40％。术后评估，三组术中无粘连者术后粘连率均为0。三组术中有粘连者术后粘连率分别为74．7％（20／27）、78．6％（22／28）、100％（27/27）。总无粘连率分别为33．3％、26．7％、10．0％，透明质酸与红霉素组粘连发生率与空白对照比较，差异有统计学意义（P〈0．05）。结论：透明质酸可减少小儿包茎、包皮环套术后包皮粘连的发生。     

小儿包茎手法扩张治疗260例

本人自 2 0 0 1年 4月至 2 0 0 2年 2月在门诊行包皮扩张治疗小儿包茎 2 60例 ,效果满意 ,报道如下。1　临床资料　　本组 2 60例患儿 ,平均年龄 7(2～ 14 )岁 ,其中包皮内板粘连 2 3 4例 (占 90 % ) ,有包皮垢 182例 (占 70 % )。　　治疗方法 :平卧 ,1%新洁尔灭局部消毒。向包皮囊腔滴入1%地卡因 1～ 2ｍｌ ;包皮内板粘连者可予 1%地卡因棉片贴敷阴茎头表面 3～ 5ｍｉｎ。蚊式止血钳扩张包茎狭窄环 ,将包皮上翻 ,露出包皮内板粘连处 ,采用分离法或剥离法分离包皮内板粘连 :①分离法 ,采用蚊式钳沿包皮与阴茎头间隙伸入 ,向阴茎头两侧分离 …     

新疆地区包茎自愈性的流行病学调查

目的 探讨新疆地区包茎的发生率及自愈趋势。方法 采用流行病学调查方法对乌鲁木齐地区1400例3～18岁儿童包茎进行检查分型，按3～5岁100名，6～18岁每岁100名共分13组。按国际包茎诊断标准将包茎分为外口狭窄型和包皮粘连型，并进行统计学分析。结果 3～9岁组儿童500例包茎发生率82％～93％，10～15岁组600例包茎发生率从74％降至6％，16～18岁组300例从4％降至1％。结论 青春期前包茎的发生率高，青春期后发生率呈明显下降趋势，至18岁仅为1％。这种明显的自愈倾向提示临床对小儿包茎的诊断和治疗应当慎重。     

单纯扩张加粘连分离术治疗小儿包茎

我们自1983年以来,采用扩张加粘连分离的方法治疗小儿包茎76例,临床疗效满意,特报告如下。临床资料:一般无需麻醉,对个别不能配合的小儿,可给予适量镇静剂或氯胺酮全麻。平卧,用0.02％洗必泰或1‰新洁而灭消毒外生殖器。术者右手持蚊式血管钳轻轻插入包皮口处,上下左右慢慢扩张包皮口,同时用左手拇食指轻轻上翻患儿包皮,发现与龟头粘连处则仔细地纯性分离,直到包皮能顺利上翻显露冠状沟而不紧张时为止。并同     

浅谈嵌顿包茎的治疗方法

包茎是包皮口狭窄或包皮与阴茎头粘连，使包皮不能上翻外露阴茎头。包皮过长是包皮覆盖于全部阴茎头和尿道口，但可上翻。嵌顿性包茎指包皮口较紧者，如将包皮勉强上翻而不及时复位，包皮口紧勒在冠状沟部，引起包皮和阴茎头的血液和淋巴液回流障碍，发生淤血、水肿、疼痛甚至可引起坏死。第三种情况一般发生在青少年患者。如性生活或手淫后，包皮上翻后而不及时复位造成，是泌尿外科门诊中的常见病之一。     

血管钳简易扩张法治疗小儿包茎

我院自 1 990年 3月～ 2 0 0 1年 1 2月应用蚊式血管钳简易扩张法治疗小儿包茎 2 6例 ,取得了满意疗效 ,现报告如下。1 　 资料与方法1 .1 　 一般资料本组 2 6例 ,年龄 2～ 6岁 ,平均 3岁。 2 0例系先天性包皮口狭小 ,最狭小者如针孔大小 ,包皮不能上翻 ,可触及包皮下包皮结石 ;6例因包茎引起包皮炎 ,使包皮与阴茎头有不同程度的粘连 ,影响包皮松动 ,加重了包茎形成 ,导致尿道外口狭窄。 1 8例有不同程度的排尿困难。1 .2 　 治疗方法在常规消毒下 ,用蚊式血管钳紧贴阴茎头部插入包茎口内 ,进至有阻力感时 ,沿阴茎左右向及背腹向等不同方向…     

评分分型对腰椎间盘突出症治疗方式选择的指导意义

目的：探讨腰椎间盘突出症评分分型对该疾病治疗方式选择的指导意义。方法：2004年1月～6月在门诊应用自行建立的腰椎间盘突出症评分分型（简称为“6分Ⅴ型法”）,对312例腰椎间盘突出症患者进行了分型,其中Ⅰ型28例（9％）。Ⅱ型72例（23％）,Ⅲ型105例（34％）,Ⅳ型66例（21％）,Ⅴ型41例（13％）;治疗原则为：Ⅰ型、Ⅱ型病人采取保守治疗,Ⅳ型、Ⅴ型手术治疗;Ⅲ型先行保守治疗3月,无效转手术治疗。现对所有病人进行门诊随访,症状体征消失且正常生活工作者判定为治愈,平均随访20个月（18～25个月）。结果：312例病人,失随访46例（15％）,随访266例（85％）;随访病人的总治愈率为87％。100例Ⅰ型和Ⅱ型病人行保守治疗,88例获随访,治愈率为93％;107例Ⅳ型、Ⅴ型病人中有95例收住院进行了手术,全部获随访,治愈率为96％;105例Ⅲ型,有26例进行了手术,全部获随访,手术治愈率为75％;保守治疗的79例中,随访63例,治愈率为71％,Ⅲ型总治愈率为73％。结论：应用腰椎间盘突出症评分分型后,对Ⅰ型和Ⅱ型病人选择保守治疗、Ⅳ型和Ⅴ型病人选择手术治疗均可以取得很好的疗效;但Ⅲ型不管选择手术治疗还是保守治疗,效果均不如其他各型;对Ⅲ型腰间盘突出症有再分亚型的必要。     

男童包茎调查6833例

男童包茎调查６８３３例吉林和龙市妇幼保健院（和龙１３３５００）崔昌熙金莲淑１９９２年６月～９月我院对６８３３例４～１３岁男童进行包茎调查，凡阴茎包皮口狭窄或包皮与阴茎头粘连，使遮盖阴茎的包皮不能上翻露出尿道口和阴茎头者或强迫上翻后引起伤害、痛苦的列为...     

评分分型对腰椎间盘突出症治疗方式选择的指导意义

目的：探讨腰椎间盘突出症评分分型对该疾病治疗方式选择的指导意义。方法：2004年1～6月在门诊应用自行建立的腰椎间盘突出症评分分型（简称为“6分Ⅴ型法”）,对312例腰椎间盘突出症患者进行了分型,其中Ⅰ型28例（9％）,Ⅱ型72例（23％）．Ⅲ型105例（34％）,Ⅳ型66例（21％）,Ⅴ型41例（13％）;治疗原则为：Ⅰ型、Ⅱ型病人采取保守治疗,Ⅳ型、Ⅴ型下术治疗;Ⅲ掣先行保守治疗3个月,无效转手术治疗。现对所有病人进行门诊随访,症状体征消火且正常生活工作者判定为治愈,平均随访20个月（18～25个月）。结果：312例病人,失随访46例（15％）,随访266例（85％）;随访病人的总治愈率为87％。100例Ⅰ型和Ⅱ型病人行保守治疗,88例获随访,治愈牢为93％;107例Ⅳ型、Ⅴ型病人中有95例收住院进行了手术,全部获随访,治愈率为96％;105例Ⅲ型,有26例进行了手术,全部获随访,手术治愈率为75％;保守治疗的79例中,随访63例,治愈率为71％,Ⅲ型总治愈率为73％。结论：应用腰椎间盘突出症评分分型后,对Ⅰ型和Ⅱ型病人选择保守治疗、Ⅳ型和Ⅴ型病人选择手术治疗均可以取得很好的疗效;但Ⅲ型不管选择下术治疗还是保守治疗,效果均不如其他各型;对Ⅲ型腰间盘突出症有再分亚型的必要。     

An 18-month follow-up study after randomized treatment of phimosis in boys with topical steroid versus placebo

OBJECTIVE: To evaluate the treatment of phimosis using topical steroid. MATERIAL AND METHODS: This was a follow-up study after a prospective, randomized, double-blind study. A total of 137 boys with phimosis were randomly assigned to either betamethasone treatment or placebo for 4 weeks, with application of the cream twice daily. Non-responders to treatment were offered steroid treatment for a further 4 weeks. All patients were invited to a follow-up examination after 18 months. RESULTS: The mean pre-treatment phimosis grades in the steroid and control groups were 5.08+/-0.66 and 4.97+/-0.70, respectively. At the 4-week follow-up, 49 boys (74%) in the steroid group were cured, compared to only 31 (44%) in the control group. Fourteen boys were circumcised after another 4 weeks of treatment; 43 of the remaining 57 boys (17 in the steroid group; 40 in the control group) had been cured. After a total of 92 boys took part in the 18-month follow-up study: 79 had been cured and 13 had suffered a relapse. Twenty-six patients did not took part in the follow-up investigation. No side-effects were noted. CONCLUSIONS: When treatment is necessary for phimosis, we recommend application of topical steroid as first-line treatment because surgery can then be avoided in 85% of cases. This first randomized, double-blind, follow-up study shows that the treatment effect persists for at least 18 months.     

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%.     

The response of balanitis xerotica obliterans to local steroid application compared with placebo in children

PURPOSE: We evaluated the clinical effectiveness of topical steroid application for balanitis xerotica obliterans in children and analyzed the association of any clinical response with histological findings. MATERIALS AND METHODS: Our double-blind, placebo controlled, randomized study included 40 boys in whom balanitis xerotica obliterans was diagnosed clinically by cicatricial phimosis. The severity of phimosis was graded into 4 groups. Patients were randomized to receive the topical application of 0.05% mometasone furoate or placebo. After 5 weeks phimosis severity was reevaluated and all patients underwent circumcision. Surgical specimens were histologically typed as an early, intermediate or late form of balanitis xerotica obliterans. RESULTS: Seven patients were withdrawn from the study. In the steroid group 7 boys had clinical improvement and 10 had no change. Histological study showed an early, intermediate and late form of balanitis xerotica obliterans in 5, 5 and 7 cases, respectively. Of cases with clinical improvement 5 were the early and 2 the intermediate type. In the placebo group 5 cases worsened clinically and 11 did not change. Histological evaluation revealed an early, intermediate and late form of balanitis xerotica obliterans in 3, 7 and 6 boys, respectively. Of the 5 cases with histological worsening, disease was the early, intermediate and late type in 2, 2 and 1, respectively. CONCLUSIONS: Applying a potent topical steroid affects improvement in balanitis xerotica obliterans in the histologically early and intermediate stages of disease, and may inhibit further worsening in the late stage.     

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.     

Topical steroid application versus circumcision in pediatric patients with phimosis: a prospective randomized placebo controlled clinical trial

Objectives Topical steroids have been advocated as an effective alternative treatment to circumcision in boys with phimosis. We evaluated the effectiveness of topical steroid therapy compared to a placebo neutral cream in 240 patients with phimosis. Methods A prospective study was carried out over a 24-months period, on an out-patient basis on two groups of patients with phimosis. One-hundred twenty patients applied a steroid cream twice a day for 4 weeks, and another group of 120 pts used a placebo cream twice a day for 4 weeks. Patients were assigned to either group by a computer-generated random choice. Results All patients in our series completed the two treatment periods without interruption. At a median follow-up of 20 months (6–30 months) therapeutic success was obtained in 43.75% (99/240) of cases, independently of the protocol. In particular, therapeutic success was obtained in 65.8% (79/120) of cases in the steroids group and in 16.6% (20/120) of cases in the placebo group, the difference being statistically significant (P < 0.0001, Mann–Withney test). Conclusion Our study shows that topical steroids represent a good alternative to surgery in case of phimosis. Steroid therapy using monometasone furoate 0.1% in our series gave better results that placebo with an overall efficacy of 65.8%. In patients where a phimotic ring persist after steroid therapy, circumcision is mandatory.     

Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect

OBJECTIVE: To compare the cost-effectiveness of surgery and topical steroids as treatments for phimosis (defined as a clinically verifiable, pathological, cicatricial stenosis of the prepuce) and to evaluate the financial basis of these treatments. METHODS: Data on treatment using topical steroids was obtained from published reports and those for circumcision from claims by private hospitals for children < 13 years old registered at the health insurance department of our facility. The estimate of the French national financial cost of the treatments for 1998 was calculated from public and private institutional information. RESULTS: Treatment with topical steroids for 4-8 weeks was successful in approximately 85% of patients (mean age 5 years) and had no side-effects; the remaining 15% were treated by circumcision. Topical steroid therapy costs (in French francs) F 360 per patient. For those primarily treated by circumcision (81 boys, mean age 4.3 years) and diagnosed as having phimosis, the cost was F 3330 per patient in the private sector. The total number of circumcisions performed in France, regardless of sector (public or private) for 1998 was estimated to be 51 080, which represents an annual cost of F 195.7 million. CONCLUSION: As topical pharmacological treatment avoids the disadvantages, trauma and potential complications of penile surgery, including anaesthesia-related risks, the use of topical steroids as a primary treatment appears to be justified in boys with clinically verifiable phimosis. This treatment could reduce costs by 75%, which represents a potential annual saving of approximately F 150 million.     

THE TREATMENT OF CHILDHOOD PHIMOSIS WITH TOPICAL STEROID

A prospective study of the efficacy of topical steroid in the treatment of childhood phimosis is reported. Boys referred to a paediatric surgical practice with pathological non-retractable foreskins were treated for at least 1 month with topical beta methasone cream. One hundred and thirty-nine patients were treated and 111 completed the study. A satisfactory result, defined as foreskin retractability appropriate for the boys' age, was achieved in 80% of patients. In 10% the response was inadequate at the end of the study period, but these boys were still under treatment or surveillance because their parents declined circumcision. In 10%, circumcision was performed because of failure of treatment. In six patients this was due to balanitis xerotica obliterans (lichen sclerosis et atrophicus) which does not respond to conservative treatment. Successful treatment depends upon the presence of a normal, supple foreskin at the outset, and on parental compliance.     

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.     

Phimotic ring topical corticoid cream (0.1% mometasone furoate) treatment in children

Background/Purpose

Phimosis, owing to the presence of a preputial fibrotic ring, is surgically treated in 1% of children. During the last decade, however, topical steroid treatment has been proposed for phimosis.

Methods

We present a double-blind study comparing 0.1% mometasone furoate topical cream vs moisturizing cream (placebo) for the treatment of phimosis. Children aged from 2 to 13 years (n = 110) presenting with phimosis (Kikiro's classification grade 5) and scheduled for circumcision were included in this trial. The patients were evaluated after 8 weeks of topical treatment with moisturizing cream (n = 54) or steroid cream (n = 56). Nonresponders from both groups received an additional 8 weeks of steroid cream treatment.

Results

In the steroid group, the ring disappeared and glans exposure was obtained in 49 (88%) of 56 patients vs 28 (52%) of 54 patients in the placebo group (P < .05). After a second treatment, in the steroid group, 5 of the 7 patients were finally cured vs 22 of the 26 in the placebo group (P < .05). Two children with persisting phimosis (Kikiro's retractability grade 5 and appearance grade 3) in the steroid group (4%) vs 4 children in the placebo group (7%) ended up receiving postectomy.

Conclusions

The present investigation adds up and supports the effectiveness of phimosis topical corticoid treatment. Nevertheless, hygiene and preputial traction, when appropriately performed, seem to play an important role in the disappearance of the phimotic ring as well. New studies are necessary to confirm if this is true or not.     

A conservative treatment of phimosis in boys

OBJECTIVE: The aim of this study was to evaluate the efficacy of topical applications of clobetasol propionate cream in the treatment of phimosis in boys and a comparison of the results presented with an overview of the current studies. METHODS: In a prospective study, 94 boys (mean age 5.5 years) were treated with topical applications of 0.05% clobetasol propionate cream twice daily. The prepuce was treated for 1 month, with an attempt at prepuce retraction after 14 days. The boys were evaluated after 1 month of treatment and every 3 months during follow-up. RESULTS: Of the 94 boys, 91 were available for follow-up, of whom 42 boys (46.1%) achieved complete retraction of the prepuce, 24 (26.4%) had only preputial adhesions and 4 (4.4%) had partial retraction. Twenty-one boys (23.1%) had no response. The treatment was continued in 13 boys with good results eventually. Seven boys (7.7%) had recurrence after a mean follow-up of 4.3 months (range 2-7). No side effects were noted. Circumcision was necessary in 24 of the 91 boys (26.4%). The mean follow-up was 11.0 months (range 3-18). CONCLUSIONS: Local application of clobetasol propionate cream is a simple, safe and effective treatment for phimosis in boys and avoids circumcision and its associated risks. It should be offered first instead of circumcision.