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No AccessJournal of UrologyAdult Urology1 Jun 2013

Circumcision and Lifetime Risk of Urinary Tract Infection: A Systematic Review and Meta-Analysis

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    Purpose:

    Urinary tract infection is common in infant males who are uncircumcised and can lead to renal parenchymal disease of the still growing pediatric kidney. Although the rate of urinary tract infection is highest in the first year of life, the cumulative incidence during the rest of the lifetime is under-recognized, but is expected to be nontrivial. Thus, any intervention that might prevent urinary tract infection would be expected to reduce suffering and medical costs.

    Materials and Methods:

    We conducted a meta-analysis of 22 studies examining the single risk factor of lack of circumcision, then determined the prevalence and relative risk of urinary tract infection in different age groups (0 to 1, 1 to 16 and older than 16 years). From these data we estimated the lifetime prevalence.

    Results:

    For age 0 to 1 year the relative risk was 9.91 (95% CI 7.49–13.1), for age 1 to 16 years RR was 6.56 (95% CI 3.26–13.2) and for older than 16 years it was 3.41-fold (95% CI 0.916–12.7) higher in uncircumcised males. We then calculated that 32.1% (95% CI 15.6–49.8) of uncircumcised males experience a urinary tract infection in their lifetime compared with 8.8% (95% CI 4.15–13.2) of circumcised males (RR 3.65, 95% CI 1.15–11.8). The number needed to treat was 4.29 (95% CI 2.20–27.2).

    Conclusions:

    The single risk factor of lack of circumcision confers a 23.3% chance of urinary tract infection during the lifetime. This greatly exceeds the prevalence of circumcision complications (1.5%), which are mostly minor. The potential seriousness of urinary tract infection supports circumcision as a desirable preventive health intervention in infant males.

    References

    • 1 : Pediatric urinary tract infections: the role of fluoroquinolones. Pediatr Infect Dis J2003; 22: 1133. Google Scholar
    • 2 : Pediatric urinary tract infections. Pediatr Clin North Am2001; 48: 1441. Google Scholar
    • 3 : Circumcision for preventing urinary tract infections in boys: North American view. Arch Dis Child2005; 90: 772. Google Scholar
    • 4 : Risk factors for urinary tract infection in children: a population-based study of 2856 children. J Paediatr Child Health2009; 45: 87. Google Scholar
    • 5 : Pyelonephritis in male infants: how important is the foreskin?. J Urol1992; 148: 733. LinkGoogle Scholar
    • 6 : Epidemiology and natural history of urinary tract infections in children. Med Clin North Am1991; 75: 287. Google Scholar
    • 7 : The prepuce, urinary tract infections, and the consequences. Pediatrics2000; 105: 8602. Google Scholar
    • 8 : Dimercaptosuccinic acid renal scintigraphy for the evaluation of pyelonephritis and scarring: a review of experimental and clinical studies. J Urol1992; 148: 1726. LinkGoogle Scholar
    • 9 : Diagnosis and management of pediatric urinary tract infections. Clin Microbiol Rev2005; 18: 417. Google Scholar
    • 10 : Urinary tract infections in children: Epidemiology, evaluation, and management. Pediatr Clin North Am1997; 44: 1133. Google Scholar
    • 11 : Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics1999; 104: 79. Google Scholar
    • 12 : Urinary tract infections. In: Nelson Textbook of Pediatrics. Edited by . Philadelphia: Saunders2007. Google Scholar
    • 13 : Renal scarring after acute pyelonephritis. Arch Dis Child1994; 71: 386. Google Scholar
    • 14 : Are younger children at highest risk of renal sequelae after pyelonephritis?. Lancet1997; 349: 17. Google Scholar
    • 15 : Typical technetium dimercaptosuccinic acid distribution patterns in acute pyelonephritis. Acta Paediatr1993; 82: 1061. Google Scholar
    • 16 : The evaluation of acute pyelonephritis and renal scarring with technetium 99m-dimercaptosuccinic acid renal scintigraphy: evolving concepts and future directions. Pediatr Nephrol1997; 11: 108. Google Scholar
    • 17 : The risk factors of recurrent urinary tract infection in infants with normal urinary systems. Pediatr Nephrol2009; 24: 309. Google Scholar
    • 18 : Neonatal circumcision: an end to the controversy?. South Med J1996; 89: 167. Google Scholar
    • 19 : Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. BMJ1989; 299: 703. Google Scholar
    • 20 : Urinary tract infections in young children. Pediatrics1982; 69: 409. Google Scholar
    • 21 : Proteus urinary infections in childhood. J Clin Pathol1972; 25: 551. Google Scholar
    • 22 : Circumcision for the prevention of significant bacteriuria in boys. Pediatr Nephrol2001; 16: 1129. Google Scholar
    • 23 : Urine testing and urinary tract infections in febrile infants seen in office settings: the Pediatric Research in Office Settings' Febrile Infant Study. Arch Pediatr Adolesc Med2002; 156: 44. Google Scholar
    • 24 : Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA2007; 298: 179. Google Scholar
    • 25 : Can circumcision prevent recurrent urinary tract infections in hospitalized infants?. Clin Pediatr (Phila)2000; 39: 699. Google Scholar
    • 26 : Urinary tract infections and the uncircumcised state: an update. Clin Pediatr (Phila)1993; 32: 130. Google Scholar
    • 27 : Circumcision for the prevention of urinary tract infections in boys: a systematic review of randomized trials and observational studies. Arch Dis Child2005; 90: 853. Google Scholar
    • 28 : Circumcision in the newborn child and risk of urinary tract infection during the first year of life: A meta-analysis. Bol Med Hosp Infant Mex1992; 49: 652. Google Scholar
    • 29 : Lack of circumcision increases the risk of urinary tract infections in young men. JAMA1992; 267: 679. Google Scholar
    • 30 : A cost-utility analysis of neonatal circumcision. Med Decis Making2004; 24: 584. Google Scholar
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