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Tomas Pantoja - One of the best experts on this subject based on the ideXlab platform.

  • The Cochrane Library - Topical corticosteroids for treating Phimosis in boys.
    The Cochrane database of systematic reviews, 2014
    Co-Authors: Gladys Moreno, Javiera Corbalán, Blanca Peñaloza, Tomas Pantoja
    Abstract:

    Background Until recently, Phimosis has been treated surgically by circumcision or prepuceplasty; however, recent reports of non-invasive treatment using topical corticosteroids applied for four to eight weeks have been favourable. The efficacy and safety of topical corticosteroids for treating Phimosis in boys has not been previously systematically reviewed. Objectives We aimed to 1) compare the effectiveness of the use of topical corticosteroid ointment applied to the distal stenotic portion of the prepuce in the resolution of Phimosis in boys compared with the use of placebo or no treatment, and 2) determine the rate of partial resolution (improvement) of Phimosis, rate of re-stenosis after initial resolution or improvement of Phimosis, and the rate of adverse events of topical corticosteroid treatment in boys with Phimosis. Search methods We searched the Cochrane Renal Group's Specialised Register through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Date of last search: 16 June 2014. Selection criteria We included all randomised controlled trials (RCTs) that compared use of any topical corticosteroid ointment with placebo ointment or no treatment for boys with Phimosis. Data collection and analysis Two authors independently assessed titles, abstracts and the full-text of eligible studies, extracted data relating to the review's primary and secondary outcomes, and assessed studies' risk of bias. Statistical analyses were performed using the random-effects model and results were expressed as risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). We contacted authors of primary articles asking for details of study design and specific outcome data. Main results We included 12 studies that enrolled 1395 boys in this review. We found that both types of corticosteroids investigated and treatment duration varied among studies. Compared with placebo, corticosteroids significantly increased complete or partial clinical resolution of Phimosis (12 studies, 1395 participants: RR 2.45, 95% CI 1.84 to 3.26). Our analysis of studies that compared different types of corticosteroids found that these therapies also significantly increased complete clinical resolution of Phimosis (8 studies, 858 participants: RR 3.42, 95% CI 2.08 to 5.62). Although nine studies (978 participants) reported that assessment of adverse effects were planned in the study design, these outcomes were not reported. Overall, we found that inadequate reporting made assessing risk of bias challenging in many of the included studies.Selection bias, performance and detection bias was unclear in the majority of the included studies: two studies had adequate sequence generation, none reported allocation concealment; two studies had adequate blinding of participants and personnel and one had high risk of bias; one study blinded outcome assessors. Attrition bias was low in 8/12 studies and reporting bias was unclear in 11 studies and high in one study. Authors' conclusions Topical corticosteroids offer an effective alternative for treating Phimosis in boys. Although sub optimal reporting among the included studies meant that the size of the effect remains uncertain, corticosteroids appear to be a safe, less invasive first-line treatment option before undertaking surgery to correct Phimosis in boys.

  • topical corticosteroids for treating Phimosis in boys
    Cochrane Database of Systematic Reviews, 2014
    Co-Authors: Gladys Moreno, Javiera Corbalán, Blanca Peñaloza, Tomas Pantoja
    Abstract:

    Background Until recently, Phimosis has been treated surgically by circumcision or prepuceplasty; however, recent reports of non-invasive treatment using topical corticosteroids applied for four to eight weeks have been favourable. The efficacy and safety of topical corticosteroids for treating Phimosis in boys has not been previously systematically reviewed. Objectives We aimed to 1) compare the effectiveness of the use of topical corticosteroid ointment applied to the distal stenotic portion of the prepuce in the resolution of Phimosis in boys compared with the use of placebo or no treatment, and 2) determine the rate of partial resolution (improvement) of Phimosis, rate of re-stenosis after initial resolution or improvement of Phimosis, and the rate of adverse events of topical corticosteroid treatment in boys with Phimosis. Search methods We searched the Cochrane Renal Group's Specialised Register through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Date of last search: 16 June 2014. Selection criteria We included all randomised controlled trials (RCTs) that compared use of any topical corticosteroid ointment with placebo ointment or no treatment for boys with Phimosis. Data collection and analysis Two authors independently assessed titles, abstracts and the full-text of eligible studies, extracted data relating to the review's primary and secondary outcomes, and assessed studies' risk of bias. Statistical analyses were performed using the random-effects model and results were expressed as risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). We contacted authors of primary articles asking for details of study design and specific outcome data. Main results We included 12 studies that enrolled 1395 boys in this review. We found that both types of corticosteroids investigated and treatment duration varied among studies. Compared with placebo, corticosteroids significantly increased complete or partial clinical resolution of Phimosis (12 studies, 1395 participants: RR 2.45, 95% CI 1.84 to 3.26). Our analysis of studies that compared different types of corticosteroids found that these therapies also significantly increased complete clinical resolution of Phimosis (8 studies, 858 participants: RR 3.42, 95% CI 2.08 to 5.62). Although nine studies (978 participants) reported that assessment of adverse effects were planned in the study design, these outcomes were not reported. Overall, we found that inadequate reporting made assessing risk of bias challenging in many of the included studies.Selection bias, performance and detection bias was unclear in the majority of the included studies: two studies had adequate sequence generation, none reported allocation concealment; two studies had adequate blinding of participants and personnel and one had high risk of bias; one study blinded outcome assessors. Attrition bias was low in 8/12 studies and reporting bias was unclear in 11 studies and high in one study. Authors' conclusions Topical corticosteroids offer an effective alternative for treating Phimosis in boys. Although sub optimal reporting among the included studies meant that the size of the effect remains uncertain, corticosteroids appear to be a safe, less invasive first-line treatment option before undertaking surgery to correct Phimosis in boys.

Gladys Moreno - One of the best experts on this subject based on the ideXlab platform.

  • The Cochrane Library - Topical corticosteroids for treating Phimosis in boys.
    The Cochrane database of systematic reviews, 2014
    Co-Authors: Gladys Moreno, Javiera Corbalán, Blanca Peñaloza, Tomas Pantoja
    Abstract:

    Background Until recently, Phimosis has been treated surgically by circumcision or prepuceplasty; however, recent reports of non-invasive treatment using topical corticosteroids applied for four to eight weeks have been favourable. The efficacy and safety of topical corticosteroids for treating Phimosis in boys has not been previously systematically reviewed. Objectives We aimed to 1) compare the effectiveness of the use of topical corticosteroid ointment applied to the distal stenotic portion of the prepuce in the resolution of Phimosis in boys compared with the use of placebo or no treatment, and 2) determine the rate of partial resolution (improvement) of Phimosis, rate of re-stenosis after initial resolution or improvement of Phimosis, and the rate of adverse events of topical corticosteroid treatment in boys with Phimosis. Search methods We searched the Cochrane Renal Group's Specialised Register through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Date of last search: 16 June 2014. Selection criteria We included all randomised controlled trials (RCTs) that compared use of any topical corticosteroid ointment with placebo ointment or no treatment for boys with Phimosis. Data collection and analysis Two authors independently assessed titles, abstracts and the full-text of eligible studies, extracted data relating to the review's primary and secondary outcomes, and assessed studies' risk of bias. Statistical analyses were performed using the random-effects model and results were expressed as risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). We contacted authors of primary articles asking for details of study design and specific outcome data. Main results We included 12 studies that enrolled 1395 boys in this review. We found that both types of corticosteroids investigated and treatment duration varied among studies. Compared with placebo, corticosteroids significantly increased complete or partial clinical resolution of Phimosis (12 studies, 1395 participants: RR 2.45, 95% CI 1.84 to 3.26). Our analysis of studies that compared different types of corticosteroids found that these therapies also significantly increased complete clinical resolution of Phimosis (8 studies, 858 participants: RR 3.42, 95% CI 2.08 to 5.62). Although nine studies (978 participants) reported that assessment of adverse effects were planned in the study design, these outcomes were not reported. Overall, we found that inadequate reporting made assessing risk of bias challenging in many of the included studies.Selection bias, performance and detection bias was unclear in the majority of the included studies: two studies had adequate sequence generation, none reported allocation concealment; two studies had adequate blinding of participants and personnel and one had high risk of bias; one study blinded outcome assessors. Attrition bias was low in 8/12 studies and reporting bias was unclear in 11 studies and high in one study. Authors' conclusions Topical corticosteroids offer an effective alternative for treating Phimosis in boys. Although sub optimal reporting among the included studies meant that the size of the effect remains uncertain, corticosteroids appear to be a safe, less invasive first-line treatment option before undertaking surgery to correct Phimosis in boys.

  • topical corticosteroids for treating Phimosis in boys
    Cochrane Database of Systematic Reviews, 2014
    Co-Authors: Gladys Moreno, Javiera Corbalán, Blanca Peñaloza, Tomas Pantoja
    Abstract:

    Background Until recently, Phimosis has been treated surgically by circumcision or prepuceplasty; however, recent reports of non-invasive treatment using topical corticosteroids applied for four to eight weeks have been favourable. The efficacy and safety of topical corticosteroids for treating Phimosis in boys has not been previously systematically reviewed. Objectives We aimed to 1) compare the effectiveness of the use of topical corticosteroid ointment applied to the distal stenotic portion of the prepuce in the resolution of Phimosis in boys compared with the use of placebo or no treatment, and 2) determine the rate of partial resolution (improvement) of Phimosis, rate of re-stenosis after initial resolution or improvement of Phimosis, and the rate of adverse events of topical corticosteroid treatment in boys with Phimosis. Search methods We searched the Cochrane Renal Group's Specialised Register through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Date of last search: 16 June 2014. Selection criteria We included all randomised controlled trials (RCTs) that compared use of any topical corticosteroid ointment with placebo ointment or no treatment for boys with Phimosis. Data collection and analysis Two authors independently assessed titles, abstracts and the full-text of eligible studies, extracted data relating to the review's primary and secondary outcomes, and assessed studies' risk of bias. Statistical analyses were performed using the random-effects model and results were expressed as risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). We contacted authors of primary articles asking for details of study design and specific outcome data. Main results We included 12 studies that enrolled 1395 boys in this review. We found that both types of corticosteroids investigated and treatment duration varied among studies. Compared with placebo, corticosteroids significantly increased complete or partial clinical resolution of Phimosis (12 studies, 1395 participants: RR 2.45, 95% CI 1.84 to 3.26). Our analysis of studies that compared different types of corticosteroids found that these therapies also significantly increased complete clinical resolution of Phimosis (8 studies, 858 participants: RR 3.42, 95% CI 2.08 to 5.62). Although nine studies (978 participants) reported that assessment of adverse effects were planned in the study design, these outcomes were not reported. Overall, we found that inadequate reporting made assessing risk of bias challenging in many of the included studies.Selection bias, performance and detection bias was unclear in the majority of the included studies: two studies had adequate sequence generation, none reported allocation concealment; two studies had adequate blinding of participants and personnel and one had high risk of bias; one study blinded outcome assessors. Attrition bias was low in 8/12 studies and reporting bias was unclear in 11 studies and high in one study. Authors' conclusions Topical corticosteroids offer an effective alternative for treating Phimosis in boys. Although sub optimal reporting among the included studies meant that the size of the effect remains uncertain, corticosteroids appear to be a safe, less invasive first-line treatment option before undertaking surgery to correct Phimosis in boys.

Jeffrey S Palmer - One of the best experts on this subject based on the ideXlab platform.

  • the efficacy of topical betamethasone for treating Phimosis a comparison of two treatment regimens
    Urology, 2008
    Co-Authors: Lane S Palmer, Jeffrey S Palmer
    Abstract:

    OBJECTIVES To compare the efficacy of two different topical betamethasone treatment regimens with respect to outcome and untoward effects in boys with Phimosis. METHODS Boys with Phimosis whose parents opted for medical management were treated with topical betamethasone (0.05%) and manual retraction. One author (J.S.P.) prescribed betamethasone twice daily (BID) for 30 days (60 doses), and the other author (L.S.P.) prescribed betamethasone thrice daily (TID) for 21 days (63 doses). All boys had severe Phimosis (prepuce unretractable to evaluate meatus) before treatment. The degree of Phimosis was graded 1 month after treatment as severe, moderate (prepuce retractable to less than 50% glanular exposure), or mild (penile adhesions). Chi-square analysis (P <0.05) was used to compare the two groups. Treatment failure was defined as persistent severe Phimosis. RESULTS A total of 200 consecutive patients from each treatment group were included. The median patient ages were similar between the groups (3.8 years BID, 4.4 years TID). One child had an untoward effect (candidal dermatitis, TID regimen). There was an 84.5% response rate (moderate to no Phimosis) with the BID regimen and an 87% response rate with the TID regimen (P = nonsignificant). Two patients with severe Phimosis before treatment were diagnosed with congenital urethral malformations (hypospadias and epispadias) after treatment. CONCLUSIONS The topical application of betamethasone is a highly efficacious, safe, and well-tolerated treatment of Phimosis in this large series of boys. The 21-day TID and 30-day BID regimens in conjunction with manual retraction are equally efficacious and can be offered to parents requesting nonsurgical management of Phimosis. Untoward effects are rare with either regimen. Important urethral anomalies can occasionally be revealed.

  • The efficacy of topical betamethasone for treating Phimosis: a comparison of two treatment regimens.
    Urology, 2008
    Co-Authors: Lane S Palmer, Jeffrey S Palmer
    Abstract:

    OBJECTIVES To compare the efficacy of two different topical betamethasone treatment regimens with respect to outcome and untoward effects in boys with Phimosis. METHODS Boys with Phimosis whose parents opted for medical management were treated with topical betamethasone (0.05%) and manual retraction. One author (J.S.P.) prescribed betamethasone twice daily (BID) for 30 days (60 doses), and the other author (L.S.P.) prescribed betamethasone thrice daily (TID) for 21 days (63 doses). All boys had severe Phimosis (prepuce unretractable to evaluate meatus) before treatment. The degree of Phimosis was graded 1 month after treatment as severe, moderate (prepuce retractable to less than 50% glanular exposure), or mild (penile adhesions). Chi-square analysis (P

Guan-yeu Diau - One of the best experts on this subject based on the ideXlab platform.

  • Topical steroid treatment of Phimosis in boys.
    The Journal of urology, 1999
    Co-Authors: Ke-chi Chen, Guan-yeu Diau
    Abstract:

    We evaluate whether steroid application alone or retraction and hygiene are responsible for successful results in boys treated with topical steroids for Phimosis. A prospective study was performed, which included a control group of 42 patients with Phimosis seen at our outpatient department from January to June 1997. During that time we trained the parent to retract and clean the foreskin only. From July 1997 to June 1998 topical steroid cream was prescribed in addition to retraction and hygiene in 276 boys with Phimosis. All cases were divided into 3 subgroups of asymptomatic, symptomatic and buried penis. The response rate was greater than 95% in patients who received topical steroid treatment in addition to improved hygiene. Only 13 boys (less than 5%) had no response to steroid treatment. Of the control patients 23 (55%) had no response to gentle retraction and personal hygiene. There was a significant difference (p<0.001) in response rate between the study and control groups. However, the subgroup with a buried penis responded poorly to steroid, retraction and hygiene treatment. There was significant difference (p<0.001) in response rate between the buried penis and other steroid groups but no significant difference (p>0.05) in the control group. Phimosis is a physiological condition in neonates due to natural adhesion between the foreskin and the glans. Chronic infection due to poor hygiene is responsible for most cases of childhood Phimosis. Circumcision is the traditional treatment of choice for Phimosis or unretractable foreskin, although it is not always desired by parents or surgeons. Topical steroid cream is an easy, safe and nonsurgical alternative for Phimosis. However, boys with a buried penis are not good candidates for steroid treatment.

Alessandro Settimi - One of the best experts on this subject based on the ideXlab platform.