From the Research
The medical term for adhesion of foreskin to the glans penis in pediatric patients is phimosis. Physiologic phimosis is normal in infants and young children, as the foreskin is naturally adherent to the glans penis at birth and gradually separates over time. Most cases resolve spontaneously by age 3-5 years without intervention. For persistent physiologic phimosis, gentle retraction during bathing and application of topical steroid cream (such as 0.05% betamethasone) twice daily for 4-6 weeks can help, as shown in a study by 1. The steroid reduces inflammation and softens the tissue, facilitating separation.
Key Points to Consider
- Parents should never forcibly retract the foreskin as this can cause scarring and pathologic phimosis.
- If conservative measures fail, or if there are complications like recurrent infections or difficulty urinating, referral to pediatric urology may be necessary.
- Pathologic phimosis, characterized by scarring and constriction of the foreskin opening, typically requires surgical intervention such as circumcision or preputioplasty.
Treatment Options
- Topical betamethasone with or without hyaluronidase has been shown to be effective in treating phimosis, with a success rate of 75.38% and 64.06%, respectively, as demonstrated in a study by 2.
- The addition of hyaluronidase to betamethasone may not significantly improve results, but it is still a safe and effective treatment option.
- The objectivation of the phimosis grade does not predict the outcome of topical steroid treatment, as shown in a study by 3.
Recommendations
- Gentle retraction and topical steroid cream should be the first line of treatment for persistent physiologic phimosis.
- Surgical intervention should be considered only if conservative measures fail or if there are complications.
- Parents should be educated on the proper use of topical steroid cream and the importance of gentle retraction to avoid scarring and pathologic phimosis.