Campbell1 states that congenital phimosis is "the only preputial anomaly of grave concern" and cites five cases of infant death secondary to uremia subsequent to congenital phimosis. Overzier2 also alludes to severe fibrous phimosis with retention of urine leading to dilatation of the upper urinary tract. However, little emphasis has been placed upon acquired phimosis as etiologic in obstructive uropathy, and one is often guided to the meatus and more proximal structures in the search for the cause of urinary tract obstruction.
The present case demonstrates how acquired phimosis and balanoposthitis can be obstructive with resultant stasis of urine, pyelocaliectasis, urinary tract infection, and bilateral acute pyelonephritis.
Report of a Case
A 16-year-old white boy presented to the Urology Clinic with symptoms of fever, chills, nausea, and difficulty in voiding of three days' duration. He had a history of difficulty in voiding, necessitating straining, which dated back "many