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Published on: January 7, 2019
Circumcision and Risk of Febrile Urinary Tract Infection in Boys with Posterior Urethral Valves: Result of the CIRCUP
Luke Harper1, T Blanc2, M Peycelon3
1Department of Pediatric Surgery, CHU de La Réunion, Saint Denis de La Réunion, France; Department of Pediatric Surgery and Urology, University Hospital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux, France.
Insights
Neonatal circumcision significantly reduces the risk of febrile urinary tract infections (fUTIs) in boys with posterior urethral valves (PUVs). This finding supports circumcision as a preventative measure in this high-risk pediatric population.
Area of Science:
- Pediatric Urology
- Infectious Disease Prevention
- Neonatal Care
Background:
- Boys with posterior urethral valves (PUVs) face a heightened risk of febrile urinary tract infections (fUTIs).
- While circumcision is thought to lower fUTI risk, robust evidence from randomized trials has been lacking.
Purpose of the Study:
- To evaluate the impact of circumcision on the incidence of fUTIs in male infants diagnosed with PUVs.
Main Methods:
- A multicenter randomized clinical trial involving 91 boys aged 1-28 days with confirmed PUVs.
- Participants were randomized to receive either antibiotic prophylaxis alone (ATB) or circumcision plus antibiotic prophylaxis (CATB).
- Follow-up was conducted for 2 years, with fUTIs defined by fever, pyuria, and positive urine culture.
Main Results:
- The incidence of fUTIs was significantly lower in the circumcision group (3%) compared to the antibiotic prophylaxis alone group (20%).
- The hazard ratio for fUTIs in the ATB group versus the CATB group was 10.3 (95% CI: 1.3-82.5).
- A complete 2-year follow-up was achieved in 70.3% of the participants.
Conclusions:
- Neonatal circumcision is a safe and effective intervention for reducing fUTI risk in boys with PUVs.
- The findings provide strong evidence supporting the use of circumcision as a preventative strategy in this vulnerable pediatric group.
- This study contributes valuable data to pediatric urology regarding infection prevention in infants with lower urinary tract anomalies.
Background:
Boys with posterior urethral valves (PUVs) have an increased risk of febrile urinary tract infections (fUTIs). Circumcision is believed to reduce the risk of fUTIs in boys, although there are no randomized trials demonstrating this.
Objective:
To determine the effect of circumcision on the risk of fUTIs in boys with PUVs.
Design, Setting, And Participants:
A clinical randomized trial that ran between August 2012 and July 2017 was conducted. The trial was multicentric, including 13 referral centers for pediatric urology. Male boys, aged 1-28 d, diagnosed with posterior urethral valves, confirmed by voiding cystogram, were included. The exclusion criteria included presence of a genital malformation contraindicating performing a circumcision.
Intervention:
Participants were randomized to neonatal circumcision + antibiotic prophylaxis (CATB) or antibiotic prophylaxis alone (ATB), and followed for 2 yr.
Outcome Measurements And Statistical Analysis:
The primary outcome was a risk of presenting fUTIs in each group. An fUTI was defined as fever (>38.5 °C) with evidence of pyuria and culture-proven infection on urinalysis, obtained by urethral catheterization or suprapubic aspiration. A bivariate analysis of the primary outcome was performed using the Kaplan-Meier method.
Results And Limitations:
In total, 91 patients were included: 49 in group CATB and 42 in group ATB. The probability of presenting an fUTI was 20% in group ATB versus 3% in group CATB. The hazard ratio of presenting an fUTI within 2 yr in the ATB group compared with that in the CATB group was 10.3 (95% confidence interval: 1.3-82.5). Sixty-four children (70.3%) had a complete follow-up at 2 yr of age.
Conclusions:
Circumcision significantly decreases the risk of presenting an fUTI in boys with PUVs.
Patient Summary:
In this report, we compared, in a multicentric trial, the number of febrile urinary tract infections (UTIs) in boys with posterior urethral valves who had either antibiotic prophylaxis alone or antibiotic prophylaxis and circumcision. We found that those who had a circumcision had a significantly lower risk of febrile UTIs.
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