Background: Phimosis is often present in the newborn period and resolves in 90% of children by the age of 3 years. Topical steroid cream has successfully treated phimosis as first line therapy particularly in countries with low neonatal circumcision rates. Over the past several years we have offered topical steroid therapy as an alternative to circumcision in an area with a high neonatal circumcision rate. We reviewed the acceptance and success rates of topical therapy over a 12 month period.
Methods: Ninety-two patients, age 6 months to 16 years, presented for "phimosis" over a 12 month period. Fifty nine of these males were identified to have uncomplicated phimosis and were offered topical steroid therapy as an alternative to circumcision. Of the remaining 32 males, 13 had a history of UTIs and circumcision was advised, 10 requested circumcision, 6 had only preputial adhesions and 3 were undergoing concurrent urologic procedures. Treatment consisted of 0.05% betamethasone cream application on a BID or TID basis until the foreskin retracted or follow-up in 4 weeks.
Results: Of the 59 patients offered topical steroid therapy or circumcision, 42 (71%) accepted topical therapy and 34 returned for follow-up. Nine patients were lost to follow-up. Two patients underwent a second course of therapy and responded. Phimosis resolved in 24 (73%) of the 34 children that returned for follow-up and persisted in 9 (27%). Amongst therapy failures, 7 (78%) reported poor compliance. The 9 children in whom therapy failed requested circumcision as opposed to another trial of therapy. Adverse effects were noted in 1 child who developed skin irritation initially which resolved with continued use of the betamethasone. When stratified by age, 7/8 (88%) of children > 10 years accepted topical therapy and these children had the highest success rate, 86%. Children 3-10 years of age had the highest failure rate, 27% (7/27) with most failures (80%) secondary to poor compliance.
Conclusions: Topical steroid therapy for phimosis is both an accepted and successful therapy in areas with high rates of neonatal circumcision, particularly in the children > 10 years of age. Treatment failure occurs more commonly in the 3 to 10 year old children and is most commonly due to poor compliance.

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