The use of betamethasone to manage the trapped penis following neonatal circumcision.

PURPOSE: The trapped penis results from cicatricial scar formation over the glans after circumcision. Management of this problem has been surgical either by incision of the cicatrix or formal surgical reconstruction. We report a series of neonates with trapped penises which were effectively managed primarily with topical steroid cream with operative intervention reserved for failed cases.

MATERIALS AND METHODS: A retrospective study of 14 neonates who presented with a trapped penis treated with topical betamethasone cream was performed. Each child underwent topical application of 0.05% betamethasone 3 times daily for 3 weeks in conjunction with manual retraction that continued after the steroid course. The need for surgical intervention was assessed during and after the treatment period.

RESULTS: All 14 boys were evaluated by the pediatric urologist within 4 weeks of circumcision. Each child had a trapped penis with a dense cicatrix of the residual foreskin distal to the glans. All parents were compliant with the regimen. There were no untoward effects of topical steroid application. Following therapy 11 boys (79%) demonstrated softening of the cicatrix with easy exposure of the glans in 2 and mild persistence of the cicatrix amenable to vertical relaxation incision in 2. The cicatrix persisted in 3 boys (14%) who required formal operative repair at ages 5 to 8 months.

CONCLUSIONS: The combination of topical betamethasone and manual retraction is effective in managing the trapped penis. This combination may affect complete resolution of the condition in the majority of patients. Otherwise, this regimen may release the closing cicatrix and allow for simple incision of the constricting phimotic ring, thus reducing the need for formal surgical repair.