Farmacoriflessioni
Corticosteroidi topici nel trattamento della fimosi
Topical steroids in the treatment of phimosis
Arianna Traunero1, Maria Grazia Scarpa2, Gianluca Tornese1,2
1Dipartimento Universitario Clinico di. Scienze Mediche Chirurgiche e della Salute, Università di Trieste
2IRCCS Materno-INfamtile “Burlo Garofolo”, Trieste
Febbraio 2025 - pagg. 91 -96 | DOI: 10.53126/MEB44091
Abstract
Phimosis is the complete or partial inability to retract the foreskin over the glans. Usually, it is a physiological condition, present from birth, and in the majority of cases resolves with variable timing during growth. Pathological phimosis occurs when the failure to retract the foreskin is caused by a distal scar tissue, secondary to recurrent balanoposthitis, trauma, or balanitis xerotica obliterans. The physiological and asymptomatic forms should not be treated as they tend to resolve spontaneously, while treatment should be reserved for its pathological or symptomatic forms, in case of balanoposthitis or recurrent urinary infections, paraphimosis and symptomatic vesicoureteral reflux or hydroureteronephrosis. This article analyses the previous studies on the use of topical steroids in the treatment of phimosis. The literature shows their high rate of efficacy in improving or resolving this condition, without significant differences between low-medium and high-potency steroids, and the absence of adverse effects. Therefore, the use of topical steroids in the distal stenotic portion of the foreskin, applied for a month (and possibly repeatable), is an optimal strategy in the initial management of phimosis, reserving surgery (circumcision) as a second-line treatment in case of failed conservative therapy.
Riassunto
La fimosi è l’incapacità completa o parziale a retrarre il prepuzio sul glande. È una condizione spesso fisiologica, presente fin dalla nascita, che nella maggioranza dei casi si risolve con la crescita, seppur con tempistiche variabili. Si parla invece di fimosi patologica quando la mancata retrazione del prepuzio è dovuta ad un fenomeno cicatriziale distale del prepuzio, secondario a balanopostiti ricorrenti, traumi, o balanite xerotica obliterante. Le forme fisiologiche ed asintomatiche non dovrebbero essere trattate in quanto tendenti alla risoluzione spontanea, mentre il trattamento andrebbe riservato alle forme patologiche o sintomatiche, in caso di balanopostiti o infezioni urinarie ricorrenti, parafimosi, in presenza di reflusso vescico-ureterale o idroureteronefrosi sintomatici.
In questo articolo vengono analizzati gli studi pubblicati in merito all’utilizzo dei corticosteroidi topici nel trattamento della fimosi. Dalla letteratura si evince l’alto tasso di efficacia nel miglioramento o nella risoluzione di tale condizione, senza differenze significative tra steroidi a bassa-media e ad alta potenza, unitamente alla pressoché assenza di effetti collaterali.
L’utilizzo dello steroide topico nella porzione stenotica distale del prepuzio, da applicare per un mese (ed eventualmente ripetibile), rappresenta quindi una strategia vincente nella gestione iniziale della fimosi, riservando la chirurgia (circoncisione) come trattamento di seconda linea nei casi refrattari alla terapia conservativa.
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Classificazione MeSH
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Corrispondenza: arianna.traunero@gmail.com