Effect of Topical Steroid Treatment for Concealed Penis: Is It Managed Conservatively?

Purpose: Phimosis can be treated using topical steroid treatment effectively. Meanwhile, concealed penis has been required surgical correction because it was considered stubborn to conservative treatment. But there were few reports of conservative treatment using topical steroid treatment for concealed penis. The aim of the present study was to evaluate the effects of topical steroid treatment for concealed penis. Materials and Methods: From December 2006 to December 2011, 30 patients (mean age 9.3 years) with concealed penis were treated with topical 0.12% bethamethasone valerate cream. Patients or their parents continued to retract the prepuce gently without causing pain and to apply a topical 0.12% bethamethasone valerate cream to the prepuce twice daily for 6 weeks. When topical steroid treatment was ineffective, patients were surgically corrected. Results: The success rate of topical steroid treatment was low (10%). 27 of 30 patients required surgical repair. No patients showed complications associated with topical steroid or surgical intervention. Conclusions: Concealed penis is highly resistant to topical steroid treatment and should be corrected surgically.

Depth of invasion to the bladder wall as a prognostic factor and its association with circulating cell-free DNA levels in patients with muscle-invasive bladder cancer

Background:Radical cystectomy(RC)is the standard surgical treatment for patients with muscle-invasive bladder cancer,but the prognosis is not favorable,and new prognostic factors need to be discovered.We investigated the potential of depth of invasion(DOI)as a prognostic factor in patients with muscle-invasive bladder cancer who underwent RC.Furthermore,we examined the association between preoperative levels of circulating cell-free DNA and DOI.Materials and methods:We retrospectively reviewed patients who underwent RC between January 2007 and December 2017;those who received neoadjuvant chemotherapy were excluded.Depth of invasion was measured using hematoxylin-eosin-stained RC specimens.Results:Of the 121 patients selected,41(33.9%)were eligible for analysis.The median follow-up period was 14 months and mean DOI was 17 mm(range,2-75 mm).Long DOI(>17 mm)was significantly associated with shorter progression-free survival(hazard ratio,14.5;95%confidence interval,3.9-53.97,p<0.0001)and cancer-specific survival(hazard ratio,18.97;95%confidence interval,4.04-88.99,p=0.0002)compared with short DOI.Multivariate analysis revealed that DOI was an independent risk factor for cancer-specific survival.The levels of circulating cell-free DNA were significantly higher in patients with a longer DOI than in those with short DOI(65 vs.20 ng/mL,respectively;p=0.028).Conclusions:Depth of invasion predicted with levels of circulating cell-free DNA and thus could be a useful prognostic factor.