|Phimosis and urinary tract infection: An Asian perspective.
|Title of book
|Living Textbook Urogenital Infection and Inflammation.
|Bjerklund Johansen TE, Wagenlehner FME, Cho YH, Matsumoto T, Krieger JN, Shoskes D, Naber K
|Edition, Volume, Page
|German Medical Science Publishing house
(City and country)
|Kanematsu Akihiro, Yamamoto Shingo
|Circumcision, the surgical removal of the prepuce, has originally been performed as a ritual procedure among people of certain religions and ethnicities. There are many studies on whether this procedure has advantageous effects on the prevention of urinary tract infection (UTI), mainly from North America and Australia, where circumcision prevalence is between 20 and 80%. Bacterial colonization in the prepuce is documented in literature and could be a legitimate reason why catheterization, but not the bag urine method, is required for uncontaminated urine collection in infants. Circumcision may, but not definitively, reduce the risk of febrile UTI in boys and breakthrough febrile UTI in males with vesicoureteral reflux (VUR). Despite several studies on this topic, there is no prospective study supporting the role of circumcision in patients with VUR to date. Therefore, the guidelines from the American Urological Association and European Association of Urology identified circumcision as an option for UTI prevention. The situation is different in most Asian countries. In Islamic Asian countries, where circumcision rate is nearly 100%, this issue does not raise any clinical concerns. In contrast, circumcision is performed in less than 20% of the males in non-Islamic Asian countries, except for South Korea and the Philippines. In countries where circumcision is not performed during childhood, it is difficult to be conceived as a therapeutic measure by both parents and physicians. The Asian guideline for UTI or sexually transmitted infection, to be published within a year, would advocate recognizing such diversity as a fundamental condition in considering the implication of circumcision in each country. In the future, development and treatment of febrile UTI (fUTI) among uncircumcised boys in these countries should be further studied in a separate context from the countries where circumcision is prevalent.