Effect of circumcision on incidence of urinary tract infection in preschool boys☆,☆☆,★,★★
Section snippets
Case selection
To identify cases of UTI in boys less than 5 years of age, we prospectively reviewed all urine cultures that were obtained from eligible boys attending the ambulatory pediatric department of the Royal Alexandra Hospital for Children, Sydney, from March 1, 1993, to Dec. 17, 1994. All urine samples were inoculated onto blood agar and MacConkey medium with a 1 μl calibrated loop. Our case criteria were a colony-forming unit count of more than 106/L from urine obtained from a suprapubic tap or
Clinical findings
One hundred forty-four cases of UTI were identified. The method of urine collection and of counting colony-forming units are given in Table I. Escherichia coli was the pathogenic organism in 124 (86.1%), Proteus sp. in 11 (7.6%), Klebsiella sp. and Escherichia faecalis in four each (2.8%), and Corynebacterium minutissimum in a single case (0.7%).13 The median age was 5.8 months, with a range of 0.3 to 54.5 months (Table II). Fever, the commonest initial symptom, was present in 111 boys (77.1%).
DISCUSSION
The association between circumcision and UTI was first recognized by Ginsberg and McCracken3 in 1982 in a cross-sectional study of 100 hospitalized infants with UTI. Despite differences in study populations and design, all subsequent studies have consistently demonstrated an association between an uncircumcised state and UTI.
The strongest evidence of a causal link between an intact foreskin and UTI comes from the series of retrospective cohort studies from Wiswell and colleagues.5, 9, 10 When
Acknowledgements
We thank Professor Geoffrey Berry for assistance with the statistical analysis; Ralph Hanson, Audrey Chan, and Peter Greenacre for technical assistance; and associate professor Les Irwig for comments on earlier drafts.
References (20)
- et al.
The prepuce: a mistake of nature?
Lancet
(1989) - et al.
Bacterial contamination rates for non-clean-catch and clean-catch midstream urine collections in uncircumcised boys
J PEDIATR
(1989) - et al.
Adherence of bacteria to human foreskins
J Urol
(1988) - et al.
Effect of circumcision status on periurethral bacterial flora during the first year of life
J PEDIATR
(1988) Complications of circumcision
Urol Clin North Am
(1983)- et al.
Association between urinary symptoms at 7 years old and previous urinary tract infection
Arch Dis Child
(1991) - et al.
Epidemiology of symptomatic urinary tract infection in childhood
Acta Paediatr Scand Suppl
(1974) - et al.
Urinary tract infections in young infants
Pediatrics
(1982) - et al.
Corroborative evidence for the decreased incidence of urinary tract infections in circumcised male infants
Pediatrics
(1986) - et al.
Declining frequency of circumcision: implications for changes in the absolute incidence and male-to-female sex ratio of urinary tract infections in early infancy
Pediatrics
(1987)
Cited by (104)
Asian guidelines for urinary tract infection in children
2021, Journal of Infection and ChemotherapyCitation Excerpt :There is one prospective randomized study [94] demonstrating reduction in episode of symptomatic febrile UTI, but statistically non-significant. Besides, same conclusion had been observed in cohort studies [95–99], a series of epidemiological studies by Wissell TE et al. [100–103], and 3 meta-analyses [103–105]. There is no prospective study for the role of circumcision in VUR patients.
Retractable foreskin reduces urinary tract infections in infant boys with vesicoureteral reflux
2021, Journal of Pediatric UrologyThe use of steroid cream for physiologic phimosis in male infants with a history of UTI and normal renal ultrasound is associated with decreased risk of recurrent UTI
2019, Journal of Pediatric UrologyCitation Excerpt :Infant males who are uncircumcised are known to be at increased risk for urinary tract infection (UTI) compared with males who are circumcised [1–8].
Management of phimosis as a risk factor of urinary tract infection: An Asian perspective
2016, Urological ScienceCitation Excerpt :Concerning the prevalence of UTI, there is one prospective randomized study demonstrating reduction in the episodes of symptomatic fUTI, although statistically the data in the study were not significant.13 In addition, there have been numerous nonrandomized studies reporting a decreased rate of fUTI in circumcised boys compared with noncircumcised boys, including cohort studies from Canada,14 Australia,15 and the United States,16–18 a series of epidemiological studies from the United States,19–22 and three meta-analyses (2 from the United States22,23 and 1 from Australia24). There are also two studies comparing the incidence of fUTI before and after circumcision, one from Turkey25 and the other from the United States.26
Do antibiotic prophylaxis and/or circumcision change periurethral uropathogen colonization and urinary tract infection rates in boys with VUR?
2013, Journal of Pediatric UrologyCitation Excerpt :Wijesinha et al. reported that most boys harbor uropathogenic organisms in their preputial flora prior to circumcision, which are replaced by skin commensals after removal of the foreskin Ref. [20]. In these studies the organisms most commonly isolated post circumcision were coagulase-negative Staphylococci [18,21], which is similar to what was observed in the present study: an increase in culture positivity from 29% (baseline) to 66% (post circumcision). The general finding was that children in groups 2 and 3 (circumcised) had lower positive urethral swab rates compared to children in groups 1 and 4.
- ☆
From the Department of Nephrology, Royal Alexandra Hospital for Children, Sydney, Australia
- ☆☆
Supported by the National Health and Medical Research Council, the Children's Hospital Research Fund, and the Manildra Group of Companies.
- ★
Reprint requests: J. C. Craig, MBChB, DCH, FRACP, Department of Nephrology, Royal Alexandra Hospital for Children, PO Box 3515, Parramatta, New South Wales 2124, Australia.
- ★★
0022-3476/96/$5.00 + 0 9/20/68991