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Circumcision reduces urinary tract infection in children with antenatal hydronephrosis: Systematic review and
Irfan Wahyudi1, Putu Angga Risky Raharja1, Gerhard Reinaldi Situmorang1
1Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia.
Insights
Circumcision significantly reduces the risk of urinary tract infections (UTI) in boys with antenatal hydronephrosis (ANH). This protective effect is consistent across various causes of ANH, highlighting its importance in preventing UTIs.
Area of Science:
- Pediatric Urology
- Infectious Disease Prevention
- Neonatal Health
Background:
- Urinary tract infections (UTI) are a significant concern in male infants diagnosed with antenatal hydronephrosis (ANH).
- Circumcision is a known factor that can reduce UTI risk.
- This study investigates the protective role of circumcision against UTI in ANH patients.
Approach:
- A systematic review and meta-analysis was conducted following PRISMA standards.
- Searched major databases (PubMed, ScienceDirect, EMBASE, Cochrane Library) up to August 2022.
- Analyzed 21 studies with 8,968 patients using Review Manager 5.4 and the Newcastle-Ottawa Scale for bias.
Key Points:
- Included 21 studies and 8,968 patients with ANH.
- UTI incidence was 18.1% in uncircumcised vs. 4.9% in circumcised boys.
- Circumcision showed a significant protective effect (OR 0.28; 95% CI 0.23-0.32) against UTI.
Conclusions:
- Circumcision is associated with a decreased incidence of UTI in children with ANH.
- The protective benefit of circumcision against UTI was observed consistently across different etiologies of hydronephrosis.
Introduction:
Urinary tract infection (UTI) is more prevalent in boys with antenatal hydronephrosis (ANH). Circumcision is known to lessen the risk of UTI. This study was performed to examine the associations between circumcision and UTI among patients with ANH.
Methods:
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed for conducting this systematic review and meta-analysis. PubMed, ScienceDirect, EMBASE, and Cochrane Library databases were searched through August 4th, 2022 to identify eligible studies. The risk of bias was measured using the Newcastle-Ottawa Scale (NOS). Review manager 5.4 was used for all analysis.
Results:
A total of 21 studies involving 8,968 patients with ANH were included in the meta-analysis. The incidences of UTI were 18.1% in the uncircumcised group and 4.9% in the circumcised group. From analysis, circumcision had significant protective effect against UTI with pooled OR of 0.28 (95% CI 0.23-0.32). The significant protective effects were also found in subgroup analysis of hydronephrosis etiology, including vesicoureteral reflux (pooled OR of 0.24; 95% CI 0.17-0.32), obstructive hydronephrosis (pooled OR of 0.34; 95% CI 0.21-0.53), and posterior urethral valve (pooled OR of 0.28; 95% CI 0.16-0.52).
Conclusion:
Our meta-analysis showed that circumcision was associated with a decreased incidence of UTI in children with ANH. This benefit was consistent irrespective of the underlying cause of hydronephrosis.
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