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.
Bacteriuria ; Female ; Hydrocortisone ; Hygiene ; Phimosis ; Pyuria ; Water

Introduction: Aside from religious circumcisions, the indications for circumcision are few. However, in the cultural context, many patients are unnecessarily referred for circumcision for physiological phimosis (adhesions). Due to parental concerns and misperceptions by general practitioners, nonretractile prepuce is one of the most common indications for referral to a paediatric surgeon in many countries. This study aimed to determine whether preputial adhesiolysis successfully managed symptomatic non-retractile foreskin and therefore prevented the need for circumcision. Methods: A retrospective review was performed of the health records of children who presented with preputial adhesion. We included 65 symptomatic patients (ballooning of the prepuce in all cases and additional dysuria in three cases) who underwent preputial adhesiolysis. All cases were followed up for 2 years. Circumcision was subsequently carried out for patients who developed fibrous scarring resulting in difficult retraction due to the development of thick adhesions or skin fissuring with persistence of symptoms. Results: Of the 65 boys, 58 (89.2%) achieved complete retraction of the prepuce. The remaining 7 boys (10.8%) presented with recurring symptoms and thick fibrosed prepuce, and they underwent circumcision due to the dense adhesions. Histopathological examination of the circumcised prepuces revealed balanitis xerotica obliterans in two cases. Conclusion Preputial adhesiolysis is a safe and effective treatment for symptomatic preputial adhesions in boys younger than 5 years old. The procedure avoids circumcision and its associated risks. Preputial adhesiolysis should be offered as a primary treatment instead of circumcision.
Phimosis ; Circumcision, Male ; Balanitis Xerotica Obliterans

A statistical observation was made on congenital anomalies of the genitourinary tract of the out-patients and in-patients in the Department of Urology, Seoul National University Hospital during the period January, 1954 through December, 1964 and the following results were obtained. I. Statistics on out-patients. 1) During the period, 17,177 cases(14,909 males and 2,268 females) seen at our out-patient Department, 262 cases (239 males, 23 females) had congenital anomalies of the genito-urinary tracts, giving a rate of 1.53%(male: 1.31 %, female: 0.22 %). 2) A gradual tendency of annual increase is observed. 3) Of 262 cases, 234 cases or 89.3 % were seen by us at the ages of 39 years or below, and 28 cases or 10.7% at the ages of 40 years or above. 4) Of the anomalies, 86 cases or 32.8 % were testicular, 77 cases or 29.3 % urethral, 54 cases or 20.6 % penile, and 1 case or 0.3% vesical, the lowest. 5) Hypospadia is observed in 31.6 % of all the anomalies, cryptorchidism in 23.6 % and congenital complete phimosis in 18.7 % II. Statistics on in-patients. 1) During the period, of 1,158 cases hospitalized (886 males, 272 females), 88 cases (76 males, 12 females) had congenital anomalies of the genito-urinary tracts, giving a rate of 7.6 % (male: 6.5%, female: 1.1%). 2) A gradual tendency of annual increase is observed. 3) Of 88 cases, 71 cases or 80.7% were seen by us at the ages of 29 years or below, and 17 cases or 19.3 % at the ages of 30 years or above. 4) Of the anomalies, 34 cases or 38.6 % were urethral, 25 cases or 28.5 % renal, 21 cases or 23.9 % testicular and 1 case or 1.1 % vesical, the lowest. 5) Hypospadia is observed in 37.5 % of all the anomalies, cryptorchidism in 23.6 % and nephroptosis in 15.9%.
Cryptorchidism ; Female ; Humans ; Hypospadias ; Male ; Outpatients ; Phimosis ; Seoul ; Urology

The beginning of the circumcision was originated from the rite of the ancient Israel historically. The circumcision has performed for the purpose of penile hygiene and for the treatment of phimosis, paraphimosis, balancposthitis and so on. In the way of the circumcision the conventional circumcision was mostly used, but we used Gomco clamp and the incision was made 3mm away from the metal edge of the instrument. And the merits in the use of the instruments were as follows: 1) the short time operation, 2) safety and cosmetically satisfactory performance without need of assistant for the procedure, 3) no bleeding on operation.
Animals ; Circumcision, Male* ; Female ; Hemorrhage ; Hygiene ; Israel ; Male ; Paraphimosis ; Phimosis

PURPOSE: We evaluated the effect of a topical steroid(0.05% clobetasol propionate[Dermovate(R)]) on phimosis. MATERIALS AND METHODS: Between May 2005 and May 2007, 30 boys with phimosis were assigned to receive topical application of Dermovate(R). Of the 30 boys, 19 boys had concealed penises. The parents of the boys were instructed to retract the foreskin gently without causing pain, and to apply the topical steroid over the stenotic opening of the prepuce twice daily for 4 weeks then for another 4 weeks if no improvement was achieved. Retractibility of the prepuce was graded from 1-6. Response to treatment was arbitrarily defined as improvement in the retractibility score(complete response, score 5 and 6; partial response, score 3 and 4; no response, score 1 and 2). The effect of treatment was studied with respect to the duration of treatment, age, and an associated concealed penis. RESULTS: The pretreatment grade in all patients was a retractibility score of 1. The mean age of the patients was 48.5+/-27.6 months(range, 7-108 months). The complete response rates in boys treated for 4 and 8 weeks were 50% and 73.3%, respectively. In boys younger than 3 years of age (n=12) and older than 3 years of age(n=18), the complete response rates were 75% and 72.2%, respectively(p=0.866). In boys with or without an associated concealed penis(n=19 and n=11, respectively), the complete response rates were 63.1% and 90.9%, respectively(p=0.199). No adverse effect was encountered in all patients. CONCLUSIONS: Our data suggest that the application of topical steroids for 8 weeks as a first line treatment of phimosis may be effective, although further studies are needed to establish the definite efficacy and safety of this procedure.
Child ; Clobetasol ; Female ; Foreskin ; Humans ; Male ; Parents ; Penis ; Phimosis ; Steroids

A statistical observation was made on congenital anomalies of the genito-urinary tracts of the out-patients and in-patients in the Department of Urology, Han Ill Hospital during the period April, 1969 through Mar. 1970 and the following results were obtained. I. Statistics on out-patients. 1) During the period, 2,115 cases (1.653 males, 462 females) bad seen at our out-patient Department, 53 cases (40 males, 13 females) bad congenital anomalies of the genito-urinary tracts, giving a rate of 2.5% (male 1.9%, female 0. 6%). 2) Of 53 cases, 49 cases (92.5%) were seen by us at the ages of 39 years or below, and 4 cases (7.6%) at the ages of 40 years or above. 3) Of the anomalies (54.7%) were in penile. 13 cases (24.5%) in renal, 5 cases (9.4%) in ureteral, 3 cases (5.7%) in urethral and 3 cases (5.7%) in testicular. 4) Congenital complete phimosis was observed in 54. 7% of all the anomalies, wandering kidney in 13.3%, ureterocele in 5.7% and hypospadia in 5. 7%. II. Statistics on in-patients 1) During the period, of 156 cases hospitalized (96 males, 60 females), 11 cases (4 males, 7 females) had congenital anomalies of the genito-urinary tracts, giving a rate of 7.1% (male: 2. 6%, female: 4.5%). 2) Of 11 cases, 10 cases (90.9%) were seen by us at the ages of 40 years or above. 3) Of the anomalies, 7 cases (63.6%) were in renal, 3 cases (27.3%) in ureteral, 1 case (9.1%) in urethral. 4) Wandering kidney was observed in 27.3% of all anomalies, ureterocele in 18.2% and double kidney in 18.2%.
Female ; Humans ; Hypospadias ; Kidney ; Male ; Outpatients ; Phimosis ; Ureter ; Ureterocele ; Urology

PURPOSE: Circumcision is widely practiced in Korea, but its implementation is still controversial, especially among younger parents. Using a questionnaire study, we tried to determine the rate of circumcision among elementary school boys and to determine parental concerns about phimosis and circumcision. We then compared our findings with previously published literature. MATERIALS AND METHODS: Between May and June 2007, we randomly selected five elementary schools and distributed self-administered questionnaires to the parents of 2,712 boys from these schools. Questions were related to children's circumcision status, age at the time of circumcision, and opinions concerning circumcision, such as its necessity and benefits. Completed questionnaires were collected and analyzed. RESULTS: The response rate was 66.2%. The overall circumcision rate of boys in elementary school was 15.4%. Some 40.3% of those boys underwent circumcision in the neonatal period, and 37.3% underwent the procedure between ages 9 and 12 years. The circumcision rate was significantly higher in boys in the higher income bracket group(29.5%) compared to boys in the middle and low income bracket groups(15.4% and 12.8%, respectively). Most boys were circumcised based on the intent of their parents(64.2%). Some 44.5% of parents believed that circumcision was necessary, while 36.3% of parents believed it was not necessary. The most common motive for circumcision was "hygiene benefits"(80.2%). CONCLUSIONS: The rates of actual circumcision practice and of approval of circumcision were lower in this report compared to previous reports. It seems that more clinical research on circumcision is needed. Physicians should provide information about circumcision to boys and their parents.
Circumcision, Male ; Female ; Humans ; Korea ; Male ; Parents ; Phimosis

Balanitis xerotica obliterans is a condition of unknown etiology with a specific clinical and histological character. It is a condition affecting the glans penis and prepuce which Stuhmer in 1928 first reported as occurring predominantly in young men following circumcision for phimosis. We report an unusual case of balanitis xerotica obliterans which developed on penis with primary urethral stone
Balanitis Xerotica Obliterans* ; Balanitis* ; Circumcision, Male ; Female ; Humans ; Male ; Penis ; Phimosis

PURPOSE: Phimosis is the inability to retract the foreskin of the penis over the glans of the penis. Even though phimosis is not pathogenic, the presence of phimosis is known to increase the risk of urinary tract infection in infancy. The use of topical steroids has been advocated as a safe and economical alternative to surgical intervention. The purpose of the study was to assess the effectiveness of topical steroids for the treatment of phimosis in young boys. METHODS: A total of 53 boys with phimosis were divided into two groups to distinguish between the efficacy of low-potency topical steroid (group 1, 27 cases) and of high-potency topical steroid (group 2, 26 cases). RESULTS: The success rate increased in the process of time. After 6 weeks, the success rate was 21 cases in group 1 and 22 cases in group 2. There was no significant differences in treatment outcomes between the two groups. The age of the boys, the appearance of prepuce prior to treatment, and the presence of previous symptoms, including symptoms of UTI, and ballooning of the prepuce at micturation had no significant difference on treatment outcomes. CONCLUSION: Topical steroid was effective in treatment of phimosis in boys younger than 4 years old. Although treatment outcomes between low- and high-potency topical steroids were not significantly different, those treated with a high-potency steroid cream showed more fast improvement. Further studies are necessary to assess systemic side effects of steroid treatment, duration of treatment and prevention of genitourinary tract infection in male infants.
Child, Preschool ; Female ; Foreskin ; Humans ; Infant ; Male ; Penis ; Phimosis* ; Steroids ; Urinary Tract Infections

Penile epispadias is extremely rare congenital anomaly. Four cases of epispadias. two of which were penile. one was penopubic and one was subsymphyseal epispadias, had been reported previously in our department. We have experienced another case of penile epispadias. Herein this case of penile epispadias have been presented. A 7-year-old boy visited this clinic for short, broad based 'tent-like' penis with complete phimosis. The glans could not be inspected due to phimosis and a gutter was palpated between the two corpora. Voiding cystourethrogram revealed dorsally displaced urethra. There was no combined urological symptoms such as dysuria, frequency in urination or urinary incontinence. Urethral reconstruction by Young's method has been performed with excellent result.
Child ; Dysuria ; Epispadias* ; Female ; Humans ; Male ; Penis ; Phimosis ; Urethra ; Urinary Incontinence ; Urination