Presentation Authors: Joshua Chamberlin*, Dao Le, Vincent Delgado, Crystal Dorgalli, Kai-Wen Chuang, Heidi Stephany, Irene McAleer, Elias Wehbi, Antoine Khoury, Orange, CA
Introduction: Circumcision reduces the risk of urinary tract infections (UTI) in boys younger than 1 year of age with vesicoureteral reflux (VUR). We sought to determine if fully retractable foreskin offers the same UTI risk reduction as circumcision.
Methods: We prospectively followed boys with primary VUR over a 2-year period. The degree of phimosis was graded on a scale of 0-5 at each visit. VUR grade, VUR laterality, and presenting indication for voiding cystourethrogram (VCUG) were obtained. Febrile UTIs were verified with pyuria and urine culture. A 2-year UTI-risk was calculated for circumcised and uncircumcised boys under 1 year of age with primary VUR based on phimosis grade over time.
Results: Since June 2014 until June 2018, 84 boys, 14 circumcised and 70 uncircumcised, under the age of 1 year were diagnosed with primary VUR and followed prospectively for 2 years. No circumcised boy with VUR had a subsequent UTI (p < 0.05). Boys with phimosis grades 4-5 had a 36.8% 2-year UTI risk, while boys with phimosis grade 3 had a 14.3% 2-year UTI risk. No UTIs were detected in the 22 boys with grade 0-2 phimosis (p < 0.05).
Conclusions: Retractable foreskin reduces UTI risk in uncircumcised boys under 1 year of age with VUR, which is similar to the benefit seen with circumcision. Medical treatment of phimosis offers similar benefit to surgical treatment of phimosis in boys under 1 year of age with VUR.