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Published on: January 7, 2019
Effect of circumcision on urinary tract infection after successful antireflux surgery
Cheol Kwak1, Seung-June Oh, Ahnkie Lee
1Department of Urology, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
Insights
Circumcision during antireflux surgery does not reduce the incidence of urinary tract infections (UTIs) in children with primary vesico-ureteric reflux (VUR). Postoperative UTI rates and renal scarring were similar in circumcised and uncircumcised groups.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Infectious Disease Prevention
Background:
- Primary vesico-ureteric reflux (VUR) is a common condition in children.
- Antireflux surgery is effective in correcting VUR, but postoperative urinary tract infections (UTIs) remain a concern.
- The potential benefit of circumcision in reducing UTIs after antireflux surgery has not been well-established.
Purpose of the Study:
- To investigate whether circumcision performed concurrently with antireflux surgery impacts the rate of postoperative UTIs in children with primary VUR.
- To compare the incidence of UTIs and renal scarring between circumcised and uncircumcised children following ureteric reimplantation.
Main Methods:
- A cohort study comparing two groups of children who underwent Cohen antireflux surgery for primary VUR: one group circumcised (n=27) and a control group not circumcised (n=50).
- Regular urine cultures were performed to detect UTIs, defined as >10(5) colony-forming units/mL of a single species.
- (99m)Tc-dimercaptosuccinic acid (DMSA) renal scans were used to assess renal parenchymal scarring before and after surgery.
Main Results:
- No significant differences were observed between the circumcised and uncircumcised groups regarding age at operation, age at first UTI, reflux grade, or pre-operative UTI episodes and renal scarring.
- Mean follow-up of 151.3 months revealed no significant difference in the number of postoperative UTI episodes between the groups.
- Follow-up DMSA scans showed no significant morphological changes or differences in scarring between the circumcised and uncircumcised cohorts.
Conclusions:
- Circumcision performed at the time of antireflux surgery does not appear to influence the incidence of postoperative UTIs in children with primary VUR.
- The study suggests that circumcision is not an effective strategy for preventing UTIs in this patient population.
- Further research may be warranted to explore other preventative measures for UTIs in children undergoing antireflux procedures.
Objective:
To evaluate whether circumcision during antireflux surgery can reduce the incidence of urinary tract infection (UTI) after successful ureteric reimplantation in patients with primary vesico-ureteric reflux (VUR).
Patients And Methods:
Children who had undergone antireflux surgery for primary VUR were divided into group 1 (27, circumcised at the time of antireflux surgery at the parents' request) and group 2 (50, those not circumcised). All antireflux operations were by the Cohen method. Regular urine samples were cultured to detect UTI, which was defined as a single species with >10(5) colony-forming units/mL in a midstream voided specimen. Numbers of UTI episodes before and after surgery were compared between the groups, with (99m)Tc-dimercaptosuccinic acid (DMSA) renal scans also taken in all patients. Each scan was blindly reviewed in terms of the size, number and zonal location of cortical defects, based on morphology. Interval changes were categorised as improved, no change, progressed, and new scar formation, and compared between the groups. Prophylactic antibiotics were maintained until the follow-up studies at 4-6 months after surgery.
Results:
There was no significant difference between the groups in age at the time of operation (mean 42.4 vs 47.4 months), the age at the first documented UTI (mean 26.5 vs 29.3 months), reflux grade, or number of UTI episodes and renal parenchymal scarring on DMSA before surgery. There was no significant difference between the groups in the number of UTI episodes at a mean (range) follow-up of 151.3 (114-207) months after antireflux surgery. Also there was no significant morphological change on follow-up renal scans and no difference between the groups.
Conclusion:
These findings suggest that circumcision during antireflux surgery has no effect on the incidence of postoperative UTI.
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