Management of phimosis as a risk factor of urinary tract infection: An Asian perspective

Many studies have been published to examine whether circumcision has any advantageous effect on the prevention of urinary tract infection (UTI), especially in male infants with vesicoureteral reflux (VUR). Colonization of bacteria in the inner prepuce and its reduction by circumcision has been documented, and circumcision may reduce the risk of febrile UTI (fUTI) in males. Circumcision is described as a therapeutic choice against VUR in the current American Urological Association and European Association of Urology/European Society for Pediatric Urology guidelines. In countries where neonatal circumcision is routinely performed, there may exist no clinical problems with regard to this issue. However, in Asian countries, there is a sharp division in the prevalence of circumcised males; for example, it is > 80% in Islamic countries, South Korea, and the Philippines, but its prevalence is < 20% in the majority of the other countries, including China, India, Japan, and Taiwan. In countries where neonatal circumcision is routinely performed, no clinical problem exists with regard to using it as a treatment for VUR. By contrast, in countries where circumcision is not routinely performed for children, strong objection exists against using this procedure for this purpose. Thus, treatment for fUTI among uncircumcised boys in these countries should be further studied in a separate context from the countries where circumcision is highly prevalent. In countries such as Korea and the Philippines where circumcision is performed during childhood, but not as a routine procedure in neonates, one may have an obligation to present circumcision as a choice of treatment for male infants with fUTI and/or VUR, and setting an appropriate age for circumcision could be an important clinical question