儿童包茎的内科治疗

目的：局部使用四环素可的松软膏治疗男孩包茎。材料和方法：对患包茎３～７岁男孩４０例随机分成两组，治疗组２０例，从包皮孔挤入四环素可的松软膏，对照组２０例使用凡士林油膏，治疗６周，观察包皮上翻程度及不良反应。结果：治疗组１８例效果良好（占９０％），对照组４例有效（占２０％）。无不良反应。结论：对３岁以上男孩包茎局部使用四环素可的松软膏治疗，方法简单可靠。     

前列腺素E_1阴茎海绵体内注射治疗功能性早泄初步报告

４０例功能性早泄病人，年龄２８～４０岁。病史半年，分成Ａ、Ｂ两组，每组２０例。Ａ组采用１０～２０μｇ前列腺素Ｅ１（ＰＧＥ１）阴茎海绵体注射；Ｂ组应用３％的丁卡因软膏阴茎头局部涂抹，每周治疗２次，疗程４周，停止治疗后１个月随访，结果显示：Ａ组治愈１３例（６５％），有效５例（２５％），疗效优于Ｂ组，无严重副作用，说明采用ＰＧＥ１阴茎海绵体注射是治疗功能性早泄的一种安全、有效的方法。     

丝白祛斑软膏联合超声波导入治疗黄褐斑疗效观察

目的：观察丝白祛斑软膏联合超声波导入治疗黄褐斑的疗效。方法：采用随机、平行对照方法，治疗组32例，使用丝白祛斑软膏联合超声波导入；对照组31例，使用丝白祛斑软膏外涂。结果：两组在治疗4周及8周时有效率（痊愈＋显效）分别为治疗组：40．63％及71．88％，对照组：16．13％、41．94％，组间比较具有显著性差异，P〈0．05；两组均未见明显不良反应。结论：丝白祛斑软膏联合超声波导入治疗黄褐斑疗效好，无明显副作用。     

包皮环切术前后包皮中触觉小体与早泄的相关性

目的观察早泄病人包皮环切术前后包皮组织中触觉小体变化情况,探讨其与早泄的关系。方法收集20～30岁早泄患者65例,按解剖及术式分为包茎组20例（传统包皮环切法）、包皮过长Ⅰ组23例（传统包皮环切法）、包皮过长Ⅱ组22例（包皮根部环切法）。用免疫组化方法对三组术前术后包皮标本中的触觉小体进行染色,显微镜下观察和统计三组包皮标本中触觉小体总数以及视野的总数,得出密度。并就三组间的差异进行统计学分析。结果三组标本中,术前包茎组和包皮过长组Ⅰ、Ⅱ中触觉小体的密度分别为36．7％和19．7％及17．5％,术后3～12月包茎组和包皮过长组Ⅰ、Ⅱ中触觉小体的密度分别为20．6％和9．7％及9．8％,手术前后其差异有显著性（P〈0．05）。结论传统包皮环切术对早泄改变效果更好。     

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。     

包皮环切结合吻合器的应用治疗包皮过长

目的：探讨使用一次性包皮环切吻合器治疗包茎、包皮过长的临床应用效果。方法：随机将220例包茎、包皮过长患者分成一次性包皮环切吻合器（A组,112）与常规包皮环切（B组,108）两组,比较其优缺点及疗效。结果：A组比B组的手术时间短、出血少、术后不需拆线、术后感染率低、术后创缘整齐,外形美观。结论：应用一次性包皮环切吻合器行包皮环切术,手术简单,并发症少,患者痛苦小,易推广。     

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。     

V字型包皮整形术在成人包茎患者中的应用效果

分析在成人包茎患者治疗中采用V字型包皮整形术的效果。方法 选取2022年11月-2023年11月 本院收治的90例成人包茎患者为研究对象,随机分为参照组和研究组,每组45例。参照组采用传统包皮 环切术治疗,研究组采用V字型包皮整形术治疗,比较两组临床疗效、美观满意度、手术指标及不良反应 发生情况。结果 研究组治疗总有效率为95.56%,高于参照组的86.67%（P＜0.05）;研究组美观满意度为 93.33%,高于参照组的84.44%（P ＜0.05）;研究组手术时间、术后持续疼痛时间、切口愈合时间及术中出 血量均优于参照组（P＜0.05）;研究组不良反应发生率为15.56%,低于参照组的64.44%（P＜0.05）。结论 V字型包皮整形术在成人包茎患者中的应用效果良好,能够有效提升治疗总有效率,优化手术指标,且术 后不良反应发生几率较小,术后美观满意度较高,     

成人包皮环扎术与环切术疗效对比分析

目的探讨包皮环扎术治疗成人包皮过长、包茎的临床效果。方法对2009至2011年438例成人包茎、包皮过长手术随机分为环扎组226例、环切组212例,并随访3个月进行疗效观察比较分析。结果手术时间分别为包皮环扎组（5±2）min和包皮环切组（32±6）min（P〈0.05）。环扎术不需包扎,护理简单,但伤口愈合时间明显长于环切组（P〈0.05）,术后并发症发生率明显高于环切组。结论包皮环扎术治疗包皮过长、包茎术后并发症较多,增加了患者的经济、精神、生活负担,暂不值得临床推广,目前还是选择传统包皮环切术治疗成人包皮过长、包茎较为理想。     

包皮环切后包皮龟头炎、包皮垢及人乳头瘤病毒感染的年龄分布调查

目的：探讨不同年龄包皮环切后人群包皮中包皮龟头炎、包皮垢及人乳头瘤病毒（ Ｈ Ｐ Ｖ）感染的发生率。　方法：对 ２１９ 例包皮环切后通过问诊和体检，了解包皮龟头炎和包皮垢的情况，采用 Ｐ Ｃ Ｒ 扩增的方法检测包皮中 Ｈ Ｐ Ｖ ６、１１、１６、１８ 及 ３３ 型 Ｄ Ｎ Ａ 保守片段。　结果：包皮龟头炎、包皮垢及 Ｈ Ｐ Ｖ 感染的发生率分别为 ２１．０％（４６／２１９）、４３．３％ （９５／２１９）和４１．１％ （９０／２１９）。　结论：包皮环切后包皮中包皮龟头炎、包皮垢及 Ｈ Ｐ Ｖ 感染的发生率较高，对于包茎或包皮过长者，应尽早行包皮环切术。     

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.     

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.     

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.     

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.     

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.     

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.     

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%.     

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.     

Ballooning of the foreskin and physiological phimosis: is there any objective evidence of obstructed voiding?

OBJECTIVES To determine whether physiological phimosis with or without ballooning of the prepuce is associated with noninvasive urodynamic or radiological evidence of bladder outlet obstruction. PATIENTS AND METHODS From August 2001 to October 2002 all boys with a foreskin problem and referred to one paediatric surgeon were assessed in special clinics. Those with physiological phimosis were recruited for the study and had upper tract and bladder ultrasonography (US), followed by uroflowmetry and US-determined postvoid residual urine volumes (PVR). Data were compared between boys with and with no ballooning of the prepuce. The project was approved by the local research ethics committee and informed consent was obtained from all study participants. RESULTS In all, 54 patients were referred for circumcision; 32 boys with physiological phimosis completed the uroflow and US investigations. Ballooning of the foreskin was present in 18 boys (mean age 6.8 years, range 3-12); 14 had physiological phimosis with no ballooning (mean age 6.5 years, range 4-11). Upper tract US and bladder wall thickness were normal in all boys. The mean maximum urinary flow rate (Q(max)) was not significantly different in boys with ballooning and those without (mean 15.3 mL/s, sd 4.4, range 9-24, vs 15.4, sd 2.9, range 10.7-20, P = 0.96). In addition, all Q(max) values were within the normal range when correlated with voided volume and compared with age-related nomograms. Most boys had flow rate patterns showing a normal bell-shaped curve; a few (9%) had subtle changes in the flow-rate profile, with either a plateau-type curve or slow initial increase in flow and prolonged time to achieve Q(max). The two groups had comparable mean PVRs (3.5 mL, sd 5.1, range 0-18 with ballooning vs 6.1, sd 10.7, range 0-38 without, P = 0.37). Only one patient had a marginally abnormal PVR. CONCLUSIONS Physiological phimosis with or without ballooning of the prepuce is not associated with noninvasive objective measures of obstructed voiding. Minor abnormalities in the flow-rate pattern in this patient group deserve further study.