Abstract
to investigate spontaneous resolution rate of a series of patients with physiologic phimosis in relation to observation time and presence of symptoms. retrospective and longitudinal follow-up study of patients with physiologic phimosis, that did not apply topic treatment. These patients were invited for a new visit for reevaluation, or recent data were obtained by chart analysis. Spontaneous resolution rate was determined and statistically compared to age, presence of symptoms at first medical visit and time until reevaluation. seventy one patients were included. Medium time of observation from first visit to reevaluation was 37.4 months. There was spontaneous resolution of phimosis in 32 (45%) patients. Children with spontaneous resolution were younger at initial diagnosis and were observed during a longer period of time. Most asymptomatic patients at first visit presented spontaneous resolution. However, it was not possible to stablish a significant relationship between presence of symptoms and evolution of physiologic phimosis. time of observation was the main determinant of spontaneous resolution of patients with physiologic phimosis, reinforcing the current more conservative approach regarding circumcision of those patients.
Highlights
Phimosis is a clinical condition where prepuce does not allow the exposure of glans[1,2]
Secondary or pathologic phimosis is defined as the absence of glans exposure due to the presence of a fibrous ring at prepuce, due to repeated balanoposthitis, ammoniacal dermatitis, or sclerous-atrophic liquen of unknown origin[5,6,7,8]
Retrospective study, with longitudinal observational follow-up, of patients up to 15 years old, attended at Pediatric Surgery Ambulatory at Clinical Hospital of Botucatu Medical School – UNESP, from 2006 to 2013, with diagnosis of phimosis; patients were in a waiting list to perform elective circumcision
Summary
Phimosis is a clinical condition where prepuce does not allow the exposure of glans[1,2]. Primary physiologic phimosis is considered when prepuce is normal ( histologically) but does not allow glans exposure and usually spontaneously resolves until adolescence[3,4]. Medical indication of circumcision is being limited, due to encouraging results of the use of topic corticoids, and natural evolution with spontaneous resolution of patients with physiologic phimosis[12,13,14]. It is being advocated to limit and postpone surgical procedure, reserving it to patients with recurrent balanoposthitis, recurrent urinary infections, to adolescents that cannot completely expose their glans and to patients with pathologic phimosis. Parents hardly believe that phimosis will spontaneously resolve and desire to anticipate surgery, even of asymptomatic patients[17]
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