Phimosis treatment with topical Betamethason: effectiveness / cost analysis
Article published in Urologia Polska 2004/57/1.

authors

Marek Orkiszewski, Marek Mackiewicz, Joanna Madej

Katedra i Klinika Chirurgii Dziecięcej i Traumatologii AM w Bydgoszczy,
Wojewódzki Szpital Dziecięcy w Toruniu
Kierownik katedry i kliniki: dr hab. Marek Orkiszewski

keywords

penis, phimosis, cost-effectiveness ratio, topical steroids

summary

introduction

It has recently been recommended to use topical steroids in the treatment of phimosis in children. Therapy appeared highly effective, free from side effects, and economically justified. The aim of the study was to analyse effectiveness / cost ratio within the national health service in Poland.

methods

Between June and September 2003, 50 patients aged between 12 mths and 10 yrs were assessed and their parents offered conservative treatment of phimosis. A 0.1% ointment of Betamethason with Neomycin was used. This was put on the stenosed part of the prepuce twice daily for 1-month. The patients were assessed at the end of their treatment. This was not ceased even when the prepuce became easily retractable before 4 weeks. The programme was used in all consecutive patients with no excluding criteria. The total cost of treatment together with prepuce adhesion release - lidocain and prilocain ointment, was calculated.

results

All the parents readily accepted the opportunity of avoiding the operation. In 92% of the patients the stenosis of the prepuce was released, in 48% the prepuce was fully retractable, while in 44% it was only partial due to adhesions. Separation of the inner prepuce from the glans under topical analgesia was always effective and free from stress and pain. In 4 patients (8%) it was impossible to retract the prepuce below the distal part of the glans. No side effects were noticed. Cost analysis showed that conservative treatment consists about 9% of the cost of surgery. Within the Polish national health service system a phimosis operation generates an inner hospital debt of 235 Euro. On the whole country scale, conservative treatment of phimosis may result in considerable economic reduction of expenditures.

conclusions

Conservative treatment of phimosis is highly effective and free from side effects of surgery. The cost of conservative treatment is considerably lower compared with surgery. This allows to reduce costs of medical treatment within the health system.

references

correspondence