Phimosis Treatment and Risk of Recurrent Urinary Tract Infection in Infant Males: A Systematic Review

Area of Science:

• Pediatric Urology
• Infectious Disease Prevention
• Systematic Review Methodology

Background:

• Phimosis, a condition of the foreskin, is associated with an increased risk of recurrent urinary tract infections (rUTI) in male infants.
• Treatment options for phimosis include circumcision and topical corticosteroids, but their efficacy in preventing rUTI is not well-established.

Purpose of the Study:

• To systematically review the existing literature on the effectiveness of circumcision and topical corticosteroid treatment for phimosis in preventing rUTI in male infants.

Main Methods:

• A comprehensive systematic review was performed across multiple databases (PubMed, Embase, Cochrane Library, etc.) up to September 2024.
• Included studies focused on primary data regarding rUTI rates following circumcision or topical corticosteroid treatment in infants with a history of UTI.
• Quality assessment and risk of bias were evaluated using Joanna Briggs Institute Critical Appraisal Tools.

Main Results:

• Only 4 studies met inclusion criteria (2 on circumcision, 2 on topical corticosteroids).
• Circumcision showed no rUTI cases post-procedure, compared to rates in uncircumcised infants (31% and 11%).
• Topical corticosteroids showed promise, with 0 rUTI in treated infants versus 16% in untreated, and higher phimosis resolution (90%) compared to Vaseline (21%).

Conclusions:

• Circumcision and topical corticosteroids appear to potentially reduce the risk of rUTI in male infants with phimosis.
• The current evidence base is limited and insufficient for a meta-analysis.
• High-quality studies are required to definitively establish the preventive role of these interventions against rUTI.