Phimosis Treatment and Risk of Recurrent Urinary Tract Infection in Infant Males: A Systematic Review.

OBJECTIVE

To evaluate the effectiveness of phimosis treatment through circumcision or topical corticosteroids in preventing recurrent UTI (rUTI) in male infants.

METHODS

A systematic review of PubMed, Embase, Cochrane Library, CINAHL, Scopus, Web of Science, and ClinicalTrials.gov was conducted through September 2024 per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English-language articles with primary data on rUTI rates post-circumcision or topical corticosteroid treatment in infants were included. Articles were excluded if participants had not experienced a prior UTI. Two authors independently assessed abstracts and articles; a third resolved discrepancies. Joanna Briggs Institute Critical Appraisal Tools were applied for quality and risk of bias.

RESULTS

Of 3283 abstracts, 69 full-text articles were reviewed, and 4 met inclusion criteria (2 on circumcision, 2 on topical corticosteroids). Around 11/35 (31%) uncircumcised premature infants and 6/53 (11%) uncircumcised boys developed a rUTI compared to none post-circumcision. Among 27 uncircumcised infants who received topical corticosteroids, none developed rUTI, versus 27/165 (16%) untreated infants. Another study found phimosis resolution in 35/39 (90%) infants using topical corticosteroids versus 8/39 (21%) using Vaseline. Infants were re-categorized by prepuce retractability, with rUTI in 2/28 (7%) infants with a retractile versus 8/27 (30%) with a non-retractile prepuce.

CONCLUSION

This first systematic review on this topic suggests circumcision and topical corticosteroids may reduce rUTI risk, but available evidence is limited and insufficient for meta-analysis. High-quality studies are needed to clarify preventive role of these interventions in rUTI.