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Journal of the Korean Society of Pediatric Nephrology 2009;13(2): 207-214. doi: https://doi.org/10.3339/jkspn.2009.13.2.207
무증상 세균뇨와 무균농뇨의 원인으로서 생리적 포경 : 스테로이드 국소 도포와 포피 위생의 효과
안정, 김태연, 김경효, 이승주
1이화여자대학교 의과대학 소아과학교실
2이화여자대학교 의과대학 소아과학교실
3이화여자대학교 의과대학 소아과학교실
4이화여자대학교 의과대학 소아과학교실
Physiologic Phimosis as a Cause of Asymptomatic Bacteriuria or Aseptic Pyuria : Therapeutic Effect of Topical Steroid Therapy and Preputial Hygiene
Jung Ahn, Tae-Yeon Kim, Kyung-Hyo Kim, Seung-Joo Lee
1Department of pediatrics, College of medicine, Ewha Wamans University
2Department of pediatrics, College of medicine, Ewha Wamans University
3Department of pediatrics, College of medicine, Ewha Wamans University
4Department of pediatrics, College of medicine, Ewha Wamans University
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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.
Key words: Nonretractile prepuce | Topical steroid therapy | Preputial hygiene
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