Ballooning of the foreskin and physiological phimosis: is there any objective evidence of obstructed voiding?

Urine flow rate curve shapes and their descriptors

AIMS

To review the descriptors and definitions of urine flow rate curve shape with a view to promoting greater clarity and to propose standard terms METHODS: A search was made in the PubMed and ICS standardization documents on urine flow rate curve shape.

RESULTS

The flow shape descriptors and their definitions are summarized and presented. "Normal" was widely used for describing a bell-shaped flow curve, and "plateau" was mostly used where the ICS describe "constrictive" flow shape. The use of shape descriptors "fluctuating," "compressive," "tower-shaped," and "intermittent" varied in the literature.

CONCLUSION

This survey provides an overview of flow shape descriptors and their definitions. We suggest it is clearer to use only descriptors that describe shape alone, that is, normal, fluctuating, intermittent, and plateau, with comments on symmetry and Q_max .

Flushing of the vagina and the prepuce-a cause for contaminated urine cultures in children

OBJECTIVE

An uncontaminated urine culture is a prerequisite for the diagnosis of a urinary tract infection. However, this may be difficult to obtain in small children. We have studied the frequency of ballooning of the prepuce in non-circumcised boys and vaginal reflux in girls during voiding as a possible cause of contaminated urine cultures.

METHODS

All micturating cystourethrograms (MCUG) performed in our institution over the last 5 years in children aged 0-15 years were reviewed retrospectively for ballooning of the foreskin or vaginal reflux as a potential source of bacterial contamination. The voiding pictures were routinely done with the catheter present for the first voiding cycle and then removed on the second void.

RESULTS

A total of 526 children (77.4 % boys, 22.6 % girls) were eligible for the study. Ballooning of the foreskin was identified on the micturition pictures of 115 (38 %) boys, with the frequency significantly higher in boys aged <12 months [odds ratio (OR) 4.1; 95 % confidence interval (CI) 2.1-7.3)] and boys with vesicoureteral reflux (OR 1.6; 95 % CI 1.06-2.4). Seventeen girls (14.3 %) showed vaginal reflux. No correlation with age or vesicoureteral reflux was found in the girls.

CONCLUSION

Ballooning of the prepuce or vaginal reflux was seen on a fluoroscopic MCUG in a large proportion of children during their voiding. This normal phenomenon might cause contaminated urine cultures when the urine is obtained by bag or clean catch.

Décalottage ou circoncision : quelle indication dans le phimosis ?

Phimosis remains a major question for mothers and induces a high number of consultations. However, large epidemiologic series have shown that congenital phimosis may disappear spontaneously in around 80% of cases with development and should'nt need any treatment before the age of five or six years old. Theses elements go against sociocultural habits which induce many circumcisions before the age of six. Corticoid treatment of phimosis seems to be very efficient to facilitate the disparition of phimosis. The aim of this literature review is to evaluate medical, socioeconomical and therapeutics aspects of phimosis. Based on these data, we recommend never to treat phimosis before the age of one year old, to wait as long as possible for spontaneous evolution of phimosis until the age of five years old, and, in case of non evolution of congenital phimosis or pathologic phimosis to use as first step treatment corticoid topics rather than surgical treatment.