[Phimosis as a pathogenetic factor in urinary tract infection and vesicoureteral reflux]

The present study has been carried out to clarify relationship between phimosis and urinary tract infection or vesicoureteral reflux. The subjects consisted of 654 boys up to 15 years old with phimosis who had been treated at the outpatient division, Fukuoka University Hospital during 13 years from 1974; 393 boys (60%) with false phimosis, 261 boys (40%) with true phimosis. Thirty three cases (5%) had abnormal voiding (weak stream, preputial ballooning, dribbling etc.) Boys with true phimosis without abnormal voiding showed high incidence of urinary tract infection compared with normal subject, and if these boys had abnormal voiding symptoms as well, the incidence of urinary tract infection, particularly in the form of pyelonephritis, was noted to be high. Therefore, we suggest that boys with phimosis should be treated surgically. The incidence of urinary tract infection in boys with false phimosis were similar to normal group. All cases except one of vesicoureteral reflux accompanied by true phimosis was diagnosed as primary reflux cystoscopically. Therefore in most cases of phimosis associated with reflux, phimosis is determined to be only an accessory factor of vesicoureteral reflux. And refluxing patients should be worked up for urinary tract infection after they have had circumcision. Only in one boy with phimosis and reflux, was the reflux thought to be secondary reflux caused by phimotic obstruction.