Circumcision lowers UTI risk in children with antenatal hydronephrosis

A new study found that circumcision was associated with a decreased incidence of UTI in children with antenatal hydronephrosis (ANH). The mechanism by which circumcision reduces UTI is most likely due to a reduction in bacterial contamination. The study results were published in the Journal of Pediatric Urology.  

Urinary tract infection (UTI) is more common in boys with antenatal hydronephrosis. Circumcision is a common procedure that is done to lessen the risk of UTI.  The American Academy of Pediatrics (AAP) consensus statement on male circumcision also recommends circumcision for boys with urological anomalies to reduce UTI incidence. As there was no meta-analysis investigating the correlations between circumcision and UTI in boys with ANH, researchers conducted a systematic review and meta-analysis to review the currently available data. 

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards, this systematic review and meta-analysis were performed. Eligible studies were identified by searching databases like PubMed, ScienceDirect, EMBASE, and Cochrane Library through August 4th, 2022. Newcastle-Ottawa Scale (NOS) was used to measure the risk of bias. Review manager 5.4 was used for all analyses. 

Results

• A total of 21 studies involving 8,968 patients with ANH were included in the meta-analysis.
• The uncircumcised group showed an incidence of 18.1% of UTI while circumscribed group showed 4.9% of UTI.
• Circumcision had a significant protective effect against UTI with pooled OR of 0.28 as noticed from the analysis (95% CI 0.23–0.32).
• Significant protective effects were also found in a subgroup analysis of hydronephrosis etiology, including vesicoureteral reflux, obstructive hydronephrosis, and posterior urethral valve. 

Thus, circumcision appears to be a successful, very straightforward, and inexpensive treatment for patients with ANH to reduce UTI. 

TAKE-HOME MESSAGE

• The authors performed a meta-analysis to determine the association between circumcision and urinary tract infections (UTIs) in boys with antenatal hydronephrosis. They found that circumcision had a significant protective effect against UTIs in boys with antenatal hydronephrosis, regardless of the etiology of hydronephrosis.
• For boys with antenatal hydronephrosis, circumcision should be discussed with parents as a method to reduce the risk of UTIs in this population.

Further reading: Wahyudi I, Raharja PAR, Situmorang GR, Rodjani A. Circumcision reduces urinary tract infection in children with antenatal hydronephrosis: Systematic review and meta-analysis [published online ahead of print, 2022 Oct 28]. J Pediatr Urol. 2022;S1477-5131(22)00471-5. doi:10.1016/j.jpurol.2022.10.029