Efficacy of Neosporin hydrocortisone cream versus preputial dilatation in children with phimosis: a comparative study

Arun M. Ainippully, Arun Preeth V., Prathap Somnath


Background: Physiological phimosis, a common complaint in the pediatric surgery outpatient department presenting as non-retractile foreskin is due to adhesions between the inner layer of the prepuce with glans penis or due to tight tip of the prepuce. These patients are managed with circumcision, preputial dilatation. In this study, we compare different outcomes measures in children treated with dilatation and those with application of Neosporin-hydrocortisone ointment.

Methods: This prospective comparative study was conducted in the department of pediatric surgery outpatient department between 2015 and 2017. We followed up 50 patients who underwent only dilatation and other 66 patients who were advised to apply only hydrocortisone impregnated antibiotic cream twice daily over a period of six weeks. We recorded basic demographic features, parent anxiety, parental compliance, parent satisfaction, complete response and persistence of phimosis at the end of the treatment. All statistical tests were done using R statistical software.

Results: Of the 116 children recruited to the study, 50(43%) belonged in the dilatation group and rest (66%) to the Neosporin-hydrocortisone (NH) group. The median age of the patients was 36 with inter-quartile range (23-48) months. Baseline characteristics were comparable across the groups. At the end of six weeks, there was statistically significant difference between the two groups with regard to all outcome measures namely parent compliance, parent satisfaction, symptom resolution with the NH group showing a better result (P value<0.0001). Moreover, Phimosis persisted in 18 (36%) of the patients treated with dilatation compared to 4 (6%) in Neosporin hydrocortisone ointment group which was statistically significant.

Conclusions: Present study shows that local application of Neosporin-hydrocortisone ointment is a better alternative to using the painful preputial dilatation in children with phimosis.


Dilatation, Foreskin, Hydrocortisone, Phimosis, Prospective studies

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Kumar P, Deb M, Das K. Preputial adhesions- a misunderstood entity. Indian J Pediatr. 2009;76(8):829-32.

Lindhagen T. Topical Clobetasol propionate compared with placebo in the treatment of unretractable foreskin. Eur J Surg. 1996;162:969-72.

Monsour MA, Rabinovitch HH, Dean GE. Medical management of phimosis in children: our experience with topical steroids. J Urol. 1999;162(3):1162-4.

Kiss A, Csontai A, Pirot L, Nyirady P, Merksz M, Kiraly L. The response of balanitis xerotica obliterans to local steroid application compared with placebo in children. J Urol. 2001;165(1):219-20.

Yilmaz E, Batislam E, Basar MM, Basar H. Psychological trauma of circumcision in the phallic period could be avoided by using topical steroids. Int J Urol. 2003;10:651-6.

Berdeu D, Sauze L, Ha-Vinh P, Blum-Boisgard C. Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect. BJU International. 2001;87(3):239-44.

Cartwright PC, Masterson TA, Snow BW. The Kelalis-King-Belman Textbook of Clinical Pediatric Urology. 5th ed. CRC Press. 2006;199-213.

Babu R, Steinbrecher HA: Urinary Tract Infection and Vesico Ureteric Reflux. In Paediatric Surgery (2nd Edition) by DM Burge, MD Griffiths, HA Steinbrecher and RA Wheeler. Arnold, London 2003.

Ashfield JE, Nickel KR, Siemens DR, MacNeily AE, Nickel JC. Treatment of Phimosis with Topical Steroids in 194 Children. The Journal of Urology 2003; 169(3): 1106-8.

Elmore JM, Baker LA, Snodgrass WT. Topical Steroid Therapy as an Alternative to Circumcision for Phimosis in Boys Younger Than 3 Years. J Urol 2002;168(4):1746-7.

Chu CC, Chen KC, Diau GY. Topical steroid treatment of phimosis in boys. J Urol. 1999;162(3):861-3.

Orsola A, Caffaratti J, Garat JM. Conservative treatment of phimosis in children using a topical steroid. Urol. 2000;56(2):307-10.

Lund L, Wai KH, Mui LM, Yeung CK. Effect of Topical Steroid on Non-retractile Prepubertal Foreskin by a Prospective, Randomized, Double-blind Study. Scandinavian J Urol Nephrol. 2000;34(4): 267-9.

Ng WT, Fan N, Wong CK, Leung SL, Yuen KS, Sze YS, et al. Treatment of childhood phimosis with a moderately potent topical steroid. ANZ Surg. 2001;71(9): 541-3.

Jorgensen ET, Svensson A. The treatment of phimosis in boys, with a potent topical steroid (Clobetasol propionate 0.05%) cream. Acta Derm Venereol. 1993;73(1):55-6.