University of Texas Southwestern Medical Center, Dallas, TX, USA.
University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Pediatr Urol. 2019 Oct;15(5):472.e1-472.e6. doi: 10.1016/j.jpurol.2019.06.018. Epub 2019 Jun 25.
An uncircumcised male infant with a history of urinary tract infection (UTI), physiologic phimosis, and a normal renal ultrasound is a common patient referred to pediatric urology clinics. Topical steroid creams have been shown to effectively release physiologic phimosis.
The objective of this study was to test the hypothesis that use of steroid cream for physiologic phimosis is associated with a lower UTI recurrence in uncircumcised male infants with normal renal ultrasounds.
Uncircumcised males younger than 12 months referred for a UTI with a normal renal ultrasound were included. A longitudinal data set was created, and recurrent UTIs were identified. The proportion with a recurrent UTI was compared between those who received a prescription for a steroid cream for phimosis and those who did not. The morbidity of the initial and recurrent UTIs was also described. The association of recurrent UTI with vesicoureteral reflux (VUR) was also evaluated.
A total of 192 uncircumcised males with a median age of 5.8 months (interquartile range [IQR]: 3.5-7.9 months) were included. Twenty-seven patients were treated with a course of betamethasone valerate 0.1% cream, and 165 were not (Summary Table). There were no significant differences between groups in the frequency of voiding cystourethrogram (VCUG), diagnosis of VUR, or use of continuous prophylactic antibiotics (CAP). During a median follow-up of 8.7 months (IQR: 3.1-17.5 months), none of the patients treated with steroid cream had a recurrent UTI compared with 27 of 165 (16%) patients not treated (P = 0.02). Among the 173 patients whose initial UTI was febrile, recurrent febrile UTIs occurred in no treated patients and 23 of 150 (15%) untreated patients (P = 0.047).
The results of this study are consistent with those of a previous randomized trial of steroid cream for physiologic phimosis which found lower recurrent UTI in those whose foreskins became retractable. In addition, the results are consistent with the declining incidence of UTIs in uncircumcised males mirroring the natural history of physiologic phimosis resolving. This study is limited by its retrospective nature and non-standardized follow-up.
The use of steroid cream for physiologic phimosis is associated with a decreased risk of recurrent UTIs in uncircumcised male infants with a normal renal ultrasound. In this group, steroid cream for physiologic phimosis is a well-tolerated and simple alternative to circumcision to potentially decrease risk of recurrent UTI.
患有尿路感染（UTI）、生理性包茎和正常肾脏超声的未割礼男婴是常见的儿科泌尿科就诊患者。局部类固醇乳膏已被证明可有效缓解生理性包茎。
本研究旨在检验以下假设：对于接受正常肾脏超声检查的未割礼男婴，使用类固醇乳膏治疗生理性包茎与 UTI 复发率降低相关。
纳入因 UTI 就诊且肾脏超声正常的年龄小于 12 个月的未割礼男婴。建立纵向数据集，识别复发性 UTI。比较接受和未接受包茎类固醇乳膏处方的患者之间复发性 UTI 的比例。还描述了首发和复发性 UTI 的发病率。还评估了复发性 UTI 与输尿管反流（VUR）的关系。
共纳入 192 名中位年龄为 5.8 个月（四分位间距 [IQR]：3.5-7.9 个月）的未割礼男婴。27 名患者接受了倍他米松戊酸酯 0.1%乳膏治疗，165 名未接受（总结表）。两组在排尿性膀胱尿道造影术（VCUG）、VUR 诊断或连续预防性抗生素（CAP）使用的频率方面无显著差异。在中位随访 8.7 个月（IQR：3.1-17.5 个月）期间，接受类固醇乳膏治疗的患者中无一例发生复发性 UTI，而未接受治疗的 165 名患者中有 27 例（16%）（P=0.02）。在 173 名初始 UTI 为发热性的患者中，未接受治疗的患者中无复发性发热性 UTI，而在 150 名未接受治疗的患者中有 23 例（15%）（P=0.047）。
本研究结果与之前关于生理性包茎类固醇乳膏的随机试验结果一致，发现包茎可回缩的患者复发性 UTI 发生率较低。此外，结果与未割礼男性 UTI 发病率下降的自然史一致，反映了生理性包茎的自然缓解。本研究受限于其回顾性性质和非标准化随访。
对于接受正常肾脏超声检查的未割礼男婴，使用类固醇乳膏治疗生理性包茎与 UTI 复发风险降低相关。在这组患者中，生理性包茎的类固醇乳膏治疗是一种耐受良好且简单的替代割礼的方法，可能降低复发性 UTI 的风险。
