Efficacy of Short Duration of Topical Steroids Followed by Adhesiolysis for Management of Preputial Adhesions.

AIMS

The primary objective was to evaluate the efficacy of a 2-week course of topical corticosteroids and outpatient adhesiolysis in managing preputial adhesions. Secondary objectives included assessing adhesion recurrence rates and monitoring adverse effects related to corticosteroid application and adhesiolysis.

MATERIALS AND METHODS

This prospective observational study was conducted at a tertiary care hospital. Boys presenting with symptoms such as inability to retract the prepuce, ballooning, penile swelling/smegma, urinary symptoms, or history of balanitis were enrolled. Preputial retractability was assessed using the KIKIROS scale. Symptomatic boys with lower KIKIROS grades underwent adhesiolysis during the first visit. Others were advised to apply topical steroids twice daily for 2 weeks, followed by adhesiolysis.

RESULTS

In the 0-<5 years group, the inability to retract prepuce with other symptoms (31%) and ballooning (26%) were common. In the 5-<10 years group, 43.8% had inability to retract the prepuce with associated conditions. In the 10-<17 years group, 64% had inability to retract the prepuce. Post-ointment KIKIROS grading was predominantly 3 in all age groups. After the fifth follow-up, 79.55% of boys who underwent adhesiolysis without ointment achieved KIKIROS 0, compared to 55.39% of those who used ointment.

CONCLUSION

Topical steroids are helpful, but adhesiolysis alone shows higher efficacy, especially for those with lower initial KIKIROS grades. Reassurance is appropriate for asymptomatic boys under five, while older boys often benefit from intervention. Post-procedure hygiene education and regular follow-up are crucial to minimize recurrence.