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Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis
Brian J Morris1, Thomas E Wiswell
1School of Medical Sciences and Bosch Institute, University of Sydney, New South Wales, Australia. brian.morris@sydney.edu.au
Insights
Uncircumcised males have a significantly higher lifetime risk of urinary tract infections (UTIs). Circumcision is a safe and effective preventive health intervention for infant males, reducing UTI incidence and potential kidney damage.
Area of Science:
- Urology
- Pediatric Nephrology
- Public Health
Background:
- Urinary tract infections (UTIs) are common in infant males, particularly those uncircumcised.
- Untreated UTIs can lead to serious complications like renal parenchymal disease in developing kidneys.
- The lifetime cumulative incidence of UTIs in uncircumcised males is substantial and often underestimated.
Purpose of the Study:
- To evaluate the association between circumcision status and the risk of urinary tract infections throughout a male's lifetime.
- To quantify the prevalence and relative risk of UTIs in different age groups.
- To determine the potential benefits of circumcision as a preventive health measure against UTIs.
Main Methods:
- A meta-analysis was performed on 22 studies focusing on circumcision as a risk factor for UTIs.
- Prevalence and relative risk of UTIs were calculated for age groups: 0-1 year, 1-16 years, and over 16 years.
- Lifetime prevalence and number needed to treat (NNT) were estimated based on the analyzed data.
Main Results:
- Uncircumcised males aged 0-1 year had a 9.91-fold higher risk of UTI. This risk remained elevated in older age groups (RR 6.56 for 1-16 years, RR 3.41 for >16 years).
- Lifetime UTI prevalence was 32.1% in uncircumcised males versus 8.8% in circumcised males (RR 3.65).
- The number needed to treat with circumcision to prevent one UTI was calculated as 4.29.
Conclusions:
- Lack of circumcision confers a significant lifetime risk (23.3%) of developing a urinary tract infection.
- This risk substantially outweighs the low incidence of circumcision complications (1.5%), which are typically minor.
- Circumcision is presented as a desirable preventive health intervention for infant males due to the potential severity of UTIs.
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.
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