Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
권호 표지
DOI QR코드

DOI QR Code

Physiologic Phimosis as a Cause of Asymptomatic Bacteriuria or Aseptic Pyuria : Therapeutic Effect of Topical Steroid Therapy and Preputial Hygiene

무증상 세균뇨와 무균농뇨의 원인으로서 생리적 포경 : 스테로이드 국소 도포와 포피 위생의 효과

  • Ahn, Jung (Department of pediatrics, College of medicine, Ewha Wamans University) ;
  • Kim, Tae-Yeon (Department of pediatrics, College of medicine, Ewha Wamans University) ;
  • Kim, Kyung-Hyo (Department of pediatrics, College of medicine, Ewha Wamans University) ;
  • Lee, Seung-Joo (Department of pediatrics, College of medicine, Ewha Wamans University)
  • 안정 (이화여자대학교 의과대학 소아과학교실) ;
  • 김태연 (이화여자대학교 의과대학 소아과학교실) ;
  • 김경효 (이화여자대학교 의과대학 소아과학교실) ;
  • 이승주 (이화여자대학교 의과대학 소아과학교실)
  • Published : 2009.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : To evaluate the cause of asymptomatic bacteriuria (AB) or aseptic pyuria (AP) on physiologic phimosis and to evaluate the effect of topical steroid therapy and preputial hygiene on the resolution of AB and AP. Methods : Ninety uncircumcised boys (age 1-72 month, median 16 month) with AB or AP were examined for physiologic phimosis and allocated by the preputial retractibility into the non-retractile group (n=59) or the retractile group (n=31). Topical steroid therapy [topical application of hydrocortisone (0.1%) cream with physiotherapy] were prescribed (three times a day) and the method of preputial hygiene (gentle retraction of prepuce and water cleansing) was instructed to the non-retractile group. After 2-4 weeks, the preputial retractibility was reevaluated and urine examination was repeated. To the retractile group, only the method of preputial hygiene was instructed and urine examination was repeated two weeks later. Results : Among 90 boys with AB and AP, 65.6% (59/90) had the nonretractile prepuces and nonperformed preputial hygiene. In the nonretractile group, the prepuces became retractile in 81.4% (48/59) after topical steroid therapy. Among boys (n=48) whose prepuces became retractile after topical steroid therapy, AB or AP resolved in 77.1%, decreased in 18.7% and persisted in 4.2%, which were significantly different to 18.2%, 2.37%, 54.5% in boys (n=11) whose prepuces were persistently nonretractile (P=0.0114). In the retractile group (n=31), 65.2% was compliant to preputial hygiene. In boys (n=23) who were compliant to preputial hygiene, AB or AP resolved in 65.2%, decreased in 26.0% and persisted in 8.2%, which were significantly different to 12.5%, 50%, 37.5% in boys (n=8) who were not compliant (P=0.0457). Conclusion : Physiologic phimosis was an important cause of AB or AP. Simple topical steroid therapy on the nonretractile prepuces and good preputial hygiene could improve AB or AP.

목적 : 무증상 세균뇨와 무균농뇨의 원인을 생리적 포경에서 찾아보고 스테로이드 국소치료와 포피 위생이 무증상 세균뇨와 무균농뇨의 소실에 미치는 치료 효과를 평가하고자 하였다. 방법 : 2004년 1월부터 2007년 12월까지 무증상 세균뇨와 무균농뇨가 확인된 90명의 남아에서 포피의 견인도에 따라 생리적 포경을 비견인 포피와 견인 포피로 구분하였고 포피 위생 여부를 확인하였다. 비견인 포피군(n=59)에서는 스테로이드 국소 치료(hydrocortisone 0.1% 크림 국소도포와 견인, 3회/일) 와 포피 위생 교육을, 견인 포피군(n=31)에서는 포피 위생 교육을 시행하였다. 포피 국소치료 2-4주 후 포피의 견인도를 재평가하였고 소변검사를 시행하여 무증상 세균뇨와 무균농뇨의 소실 정도를 평가하였다. 결과 : 무증상 세균뇨와 무균농뇨를 보인 남아의 65.6%에서 비견인 포피가 관찰되었고 대상아 모두(100%)에서 포피 위생을 시행하지 않았었다. 비견인 포피군(n=59)에서 스테로이드 국소 치료 후에 48명(81.4%)에서 견인 포피로 호전되었다. 견인포피로 전환된 경우(n=48), 무증상 세균뇨와 무균농뇨는 77.1%에서 소실, 18.7%에서 감소, 4.2%에서 지속되었고 이는 비견인 포피가 지속된 경우(n=11)의 18.2%, 27.3%, 54.5%에 비하여 유의하게 호전되었다(P=0.0014). 견인포피군(n=31)에서는 포피 위생에 순응한 경우(n=23)에 무증상 세균뇨/무균성 농뇨가 65.2%에서 소실, 26.0%에서 감소, 8.2%에서 지속되어 포피 위생에 순응하지 않은 경우(n=8)의 12.5%, 50%, 37.5%에 비하여 유의하게 호전되었다(P=0.0457). 결론 : 생리적 포경이 무증상 세균뇨와 무균농뇨의 중요한 원인이며 비견인 포피에 대한 스테로이드 국소 치료나 포피 위생 등 간단한 치료로 무증상 세균뇨와 무균농뇨의 상당수가 호전될 수 있었다.

Keywords

References

  1. Jodal U. The natural history of bacteriuria in childhood. Infect Dis Clin North Am 1987;1:713-29.
  2. Wettergren B, Jodal U. Spontaneous clearance of asymptomatic bacteriuria in infants. Acta Paediatr Scand 1990;79:300-4. https://doi.org/10.1111/j.1651-2227.1990.tb11460.x
  3. Raz R. Asymptomatic bacteriuria. clinical significance and management. Int J Antimicrob Agents 2003;22:45-7. https://doi.org/10.1016/S0924-8579(03)00248-6
  4. Bensman A, Ulinski T. Pharmacotherapy of lower urinary tract infections and pyelonephritis in children. Expert Opin Pharmacother 2009;10:2075-80. https://doi.org/10.1517/14656560903095273
  5. U.S. Preventive Services Task Force. Screening for asymptomatic bacteriuria in Adults: U.S. Preventive Services Task Force Reaffinnation Recommendation Statement. Annals of Internal Medicine 2008;149:43-7. https://doi.org/10.7326/0003-4819-149-1-200807010-00009
  6. Blanco M. Blanco JE, Alonso MP, Blanco J. Virulence factors and O groups of Escherichia coli isolates from patients with acute pyelonephritis, cystitis and asymptomatic bacteriuria. Eur J Epidemiol 1996;12:191-8. https://doi.org/10.1007/BF00145506
  7. Schnarr J, Smaill F. Asymptomatic bacteriuria and symptomatic urinary tract infection in pregnancy. Eur J Clin Invest 2008;38:50-7. https://doi.org/10.1111/j.1365-2362.2008.02009.x
  8. Rodhe N, Lofgren S, Matussek A, Andre M, Englund L, Kuhn I, et al. Asymptomatic bacteriuria in the elderly: high prevalence and high turnover of strain. Scand J Infec Dis 2008;40:804-10. https://doi.org/10.1080/00365540802195242
  9. Robert M, Richard E, Hal B, Bonita F. Nelson Textbook of Pediatrics 18th ed. Philadelphia: W.B Sounders Co, 2007:2221-34.
  10. Ginsburg CM, McCracken GH. Urinary tract infections in young infants. Pediatrics 1982;69:409-12.
  11. Wiswell TE, Smith FR, Bass JW. Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics 1985;75:901-3.
  12. Schoen EJ, Colby CJ, Ray GT. Newborn circumcision decreases incidence and costs of urinary tract infections during the first year of life. Pediatrics 2000;105:789-93. https://doi.org/10.1542/peds.105.4.789
  13. American Academy of Pediatrics. Task force on circumcision. Circumcision policy statement. Pediatrics 1999;103:686-93. https://doi.org/10.1542/peds.103.3.686
  14. Fussell EN, Kaack MB, Cherry R, Roberts JA. Adherence of bacteria to human foreskin. J Urol 1988;140:997-1001.
  15. Wiswell TE, Miller GM, Gelston HM, Jones SK, Clemmings AF. Effect of circumcision status on periurethral bacterial flora during the first year of life. J Pediatr 1988;113:442-6. https://doi.org/10.1016/S0022-3476(88)80625-5
  16. Lee SJ. Relationship between infant urinary tract infection and neonatal circumcision. Korean J Pediatr 1992;35;1035-43.
  17. Savas C, Cakmak M, Yorgancigil B, Bezir M. Comparison of preputial sac and urine cultures in healthy children. Int Urol Nephrol 2000;32:85-7. https://doi.org/10.1023/A:1007120520884
  18. Nayir A. Circumcision for the prevention of significant bacteriuria in boys. Pediatr Nephrol 2001;16:1129-34. https://doi.org/10.1007/s004670100044
  19. Wijesinha SS, Atkins B.L, Dudley N.E, Tam PK. Does circumcision alter the periurethral bacterial flora- Pediatr Surg Int 1998;13:146-8. https://doi.org/10.1007/s003830050270
  20. Robert S. Cost effective treatment of phimosis. Pediatrics 1998;102:E43. https://doi.org/10.1542/peds.102.4.e43
  21. Elmore JM, Baker LA, Snodgrass WT. Topical steroid therapy as an alternative to circumcision for phimosis in boys younger than 3 years. J Urol 2002;168:1746-7. https://doi.org/10.1016/S0022-5347(05)64404-7
  22. Ku WH, Chiu BS, Huen KF. Outcome and recurrence in treatment of phimosis using topical betamethasone in children in Hong Kong. J Pediatr Child Health 2007;43:74-9. https://doi.org/10.1111/j.1440-1754.2007.01006.x
  23. Lee JW, Cho SJ, Park EA, Lee SJ. Topical hydrocortisone and physiotherapy for nonretractile physiologic phimosis in infants. Pediatr nephrol 2006;21:1127-30. https://doi.org/10.1007/s00467-006-0104-8
  24. Kayaba H, Tamura H, Kitajima S, Fujiwara Y, Kato T, Kato T. Analysis of shape and retractability of the prepuce 603 Japanese boys. J Urol 1996;156:1813-5. https://doi.org/10.1016/S0022-5347(01)65544-7
  25. Edgar J. Should newborns be circumcised- Yes. Can Fam Physician 2007;53:2096-8.
  26. Yilmaz E, Batislam E, Basar MM, Basar H. Psychological trauma of circumcision in the phallic period could be avoided by using topical steroids. Int J Urol 2003;10:651-6. https://doi.org/10.1046/j.1442-2042.2003.00722.x
  27. Krueger H. Osborn L. Effects of hygiene among the uncircumcised. J Fam Pract 1986;22:353-5.