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You have sent too many requests causing Linguee to block your computerThe objective of our steroid information for parents was to assess the efficacy of topical steroids in the treatment of phimosis and evaluate patients using the Diagnostic and Statistical Manual-III-Revised DSM-III- R test with the aim of eliminating castration anxiety of circumcision in the phallic period. One hundred and forty-nine children with phimosis who required circumcision were included the study. The average age of the children was 4. Patients were separated randomly into hund rude kastration kosten groups. Group I comprised 51 children who would undergo circumcision; group II comprised 50 children who would be treated with a topical corticosteroid 0. On the 5th day of treatment, parents were told to retract the prepuce and were given hygiene routine instructions.
The objective of our study was to assess the efficacy of topical steroids in the treatment of phimosis and evaluate patients using the Diagnostic and Statistical Manual-III-Revised DSM-III- R test with the aim of eliminating castration anxiety of circumcision in the phallic period. One hundred and forty-nine children with phimosis who required circumcision were included the study.
The average age of the children was 4. Patients were separated randomly into three groups. Group I comprised 51 children who would undergo circumcision; group II comprised 50 children who would be treated with a topical corticosteroid 0.
On the 5th day of treatment, parents were told to retract the prepuce and were given hygiene routine instructions. Patients were seen immediately after treatment and again 2 months later. In group II, 16 of the 50 children had non-retractable prepuce.
Forty-two cases of phimosis were corrected after treatment. Eight patients received further monthly treatment and five benefited from the second course of treatment. In group III, 17 of the 48 patients had non-retractable prepuce and four had satisfactory results. Forty-four patients received placebo treatment for another month and eventually, 40 children underwent circumcision in this group.
There were no significant differences in the other groups. Topical steroids for the treatment of phimosis is a highly effective treatment alternative to surgery. It avoids or delays circumcision and can be practised during the phallic period to decrease castration anxiety. The treatment is suitable for patients from any religious or cultural background. Circumcision is the most frequently practiced surgery in Turkey for religious and traditional purposes. Most of the operations are performed in neonates and primary school children.
Awareness of the phallic structure and gender identity develops during the phallic period. Therefore, circumcision may sometimes be imagined as the total loss of genitalia. Cansever assessed 12 boys before and after they were circumcised and reported severe functional disturbances after circumcision as measured by psychological testing. He cited the trauma of circumcision as an example. Phimosis is defined as the narrowing of the opening of foreskin, which makes it difficult to retract the foreskin to the coronal sulcus.
During the neonatal period and up to 3 years of age, physiologic phimosis is common and the prepuce cannot be retracted. When inflammatory processes and voiding difficulties are predominant, phimosis is the reason for performing circumcision before the planned time. The authors of this study used outmoded diagnostic criteria to determine the existence of phimosis in very young boys.
It is probable that most of these boys would have achieved retractable foreskins without treatment in the course of time. For more information on the normal development of the foreskin see Normal. Topical steroids have proved to be effective in most phimotic patients. Our study was based on the idea that circumcision in patients with phimosis between the ages of 3 and 6 years can be delayed with the use of topical steroids to avoid castration anxiety phenomenon. Between December and June , children with phimosis between the ages 3 and 6 years were included in the study group.
Children were randomly separated into three groups. Group I comprised 51 children who would undergo circumcision, group II comprised 50 children who would be treated with a topical corticosteroid bethametasone 0.
After 5 days of treatment, prepuces were retracted by parents each day throughout the treatment. Hygiene instructions were given to parents and children.
All patients were assessed for the type of phimosis and classified as either: Control examinations were held immediately after treatment and again after 1 and 2 months.
The outcome was defined as: The parents provided informed consent for entering their children into the study. Children and parents were evaluated and given information about the treatment by a urologist and a child and adolescent psychiatrist 1 month before treatment.
Parents were told to observe the child for 1 month and their observations were recorded at the end of this period. The aim of the observation and DSM-III-R evaluation was to assess the possibility of castration anxiety, particularly in the circumcision group compared to the other two groups. Circumcision was performed accordingly in 51 children by the guillotine technique under ketamine anesthesia. There were no postoperative complications in any of the cases.
All patients were re-evaluated after 1 month and again after 2 months in the steroid and placebo groups. Of the 51 patients in groups I, 22 had a retractable prepuce, 16 had non-retractable prepuce and 13 had pinpoint opening prepuce. In the circumcision group, during the 1 month period before circumcision, 44 children displayed some degree of isolation, aggression towards the family members, disruption in relations with friends and fear of being alone.
However, in the topical corticosteroid and placebo groups these type of disorders were detected in only three and two of the children, respectively. Three patients required circumcision because they did not respond to the treatment.
Open Table Three in new window. In group III, four patients 8. The remaining 40 patients underwent circumcision. Patient age groups and success rates are shown in Tables 4 and 5. Circumcision, a ritual as old as written history, has been applied extensively in many countries, predominantly for religious and traditional reasons.
However, in cases of phimosis, paraphimosis and various infective disorders of the prepuce, circumcision is applied as a medical procedure. Regardless of the reason for circumcision, it is commonly accepted that the most appropriate periods in which to perform the surgery are the newborn and primary school periods. Surgical operations and circumcision on genitalia throughout the phallic period are not recommended and should be performed only if they are unavoidable.
During child development, despite the controversy that surrounds the theory, the Oedipus phenomenon is defined as one of the most important periods of life. Many psychiatric methods study childhood developmental stages to detect various psychological and behavioral disorders.
In addition, many psychological disturbances are linked to the developmental stage. Freud named the psychodevelopmental stage between the ages of 3 and 5 years as the Oedipal stage and gave special importance to the pathogenesis of neuroses, anxiety disorders, hysterical personality and obsessive-compulsive personality during this period.
Resolution of this stage in males begins at around 6 years of age. Therefore, this stage referred to as the stage of genital fears. In the late 19th and early 20th century, Freud identified castration anxiety as the result of fear of operations on the genitals. The USA male children were circumcised while the European children were not circumcised; therefore it was suggested that the changes were due to circumcision.
These were deemed to be exactly the same as those experienced by a helpless infant undergoing circumcision. McFadyen reported the psychological trauma experienced by her son following circumcision. Failure to grieve the loss leaves the individual in a state of denial of loss and disconnected from the reality of loss and injury. Topical steroids are well established agents for the treatment of phimosis and are a good alternative to surgery. The application of topical steroids is an easy, effective and low-cost treatment for phimosis.
In populations where circumcision is a cultural necessity, medical therapy for phimosis with topical steroids can be justified, particularly during the phallic period. Key words castration anxiety, phallic period, phimosis, topical steroid.
Introduction Circumcision is the most frequently practiced surgery in Turkey for religious and traditional purposes. Methods Between December and June , children with phimosis between the ages 3 and 6 years were included in the study group.
Results All patients were re-evaluated after 1 month and again after 2 months in the steroid and placebo groups. Discussion Circumcision, a ritual as old as written history, has been applied extensively in many countries, predominantly for religious and traditional reasons.
Conclusion The application of topical steroids is an easy, effective and low-cost treatment for phimosis. Theories of personality and psychopathology: Psychological effects of circumcision. Signs and sequelae as seen in the analysis of an adolescent. Reflections on the problem of psychic trauma. Circumcision and phimosis -indications and results. The conservative treatment of phimosis in boys. Jorgensen ET, Svenson A.
The treatment of phimosis in boys, with a potent topical steroid clobetasol propionate 0. Conservative treatment of phimosis in children using a topical steroid. Topical steroid treatment of phimosis in boys. Medical management of phimosis in children: Our experience with topical steroids. The treatment of childhood phimosis with topical steroid.
Topical clobetasol propionate compared with placebo in the treatment of unretractable foreskin. Treatment of childhood phimosis with topical steroid [letter]. Standard Edition ; American Psychiatric Association Post-traumatic stress disorder.
Children have feelings too. Maguire P, Parkes CM. Surgery and loss of body parts. A nonsurgical approach to the treatment of phimosis: Local nonsteroidal anti-inflammatory ointment application.
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