Circumcision for the prevention of urinary tract infection in boys: A systematic review of randomized trials and observational studies

Davinder Singh-Grewal ¹, Joseph Macdessi ^1* and Jonathan Craig ²

¹ Department of Paediatrics and Child Health, The Children's Hospital at Westmead, Sydney, Australia
² Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia

^* To whom correspondence should be addressed. E-mail: josephm{at}chw.edu.au.

Accepted 9 August 2004

Abstract

Objective:Circumcision is the most frequently performed surgical procedure in boys. This systematic review summarises the existing data about the effect of circumcision on the risk of urinary tract infection in boys.

Data Sources:Randomised controlled trials and observational studies comparing the frequency of urinary tract infection in circumcised and uncircumcised boys were identified from the Cochrane Controlled Trials Register, MEDLINE, EMBASE, reference lists of retrieved articles and contact with known investigators.

Review methods:Two of the authors independently assessed study quality using the guidelines provided by the MOOSE Statement for quality of observational studies.

Results:Data from 402,908 children was identified from twelve studies (one randomised controlled trial, four cohort studies and seven case control studies). A random effects model was used to estimate a summary odds ratio (OR) with 95% confidence intervals (CI). Circumcision was associated with a significantly reduced risk of urinary tract infection (OR 0.13; 95%CI, 0.08- 0.20; p<0.001) with the same odds ratio (0.13) for all three study designs.

Conclusion:Circumcision substantially reduces the risk of urinary tract infection. Given a risk of UTI in normal boys of about 1%, the number-needed-to treat to prevent one urinary tract infection is 111. In boys with recurrent urinary tract infection or high-grade vesicoureteric reflux , the risk of urinary tract infection recurrence is 10% and 30% and the numbers needed-to-treat are 11 and 4 respectively. Haemorrhage and infection are the commonest complications of circumcision occurring at rate of about 2% and assuming equal utility of benefits and harms, net clinical benefit is only likely in boys at high risk of urinary tract infection.

Keywords: circumcision, sytematic review, urinary tract infection

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