The role of circumcision in preventing urinary tract infections in children with antenatal hydronephrosis: Systematic review and meta-analysis

Justin Yh Chan; Adree Khondker; Min Joon Lee; Jin Kyu Kim; Margarita Chancy; Michael E Chua; Joana Dos Santos; Natasha Brownrigg; Juliane Richter; Armando J Lorenzo; Mandy Rickard

doi:10.1016/j.jpurol.2023.07.017

The role of circumcision in preventing urinary tract infections in children with antenatal hydronephrosis: Systematic review and meta-analysis

J Pediatr Urol. 2023 Dec;19(6):766-777. doi: 10.1016/j.jpurol.2023.07.017. Epub 2023 Aug 2.

Affiliations

¹ Division of Urology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, ON, Canada.
² Division of Urology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada.
³ Division of Urology, Department of Surgery, University of Toronto, ON, Canada.
⁴ Division of Urology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, ON, Canada. Electronic address: mandy.rickard@sickkids.ca.

PMID: 37563014
DOI: 10.1016/j.jpurol.2023.07.017

Abstract

Introduction: Circumcision has been reported to reduce the risk of urinary tract infections (UTIs) in boys with antenatal hydronephrosis (HN). Our aim was to compare the incidence of UTIs in circumcised vs. uncircumcised boys with antenatal HN by conducting a systematic review and meta-analysis.

Study design: A comprehensive search was performed until December 2022. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed measures included: UTIs, continuous antibiotic prophylaxis (CAP) use, renal outcomes, and circumcision complications. Odds ratios (OR) and mean difference with 95% confidence interval (CI) were extrapolated from available data. Random-effects meta-analysis were performed.

Results: Twenty-three studies describing 9093 boys with antenatal HN were identified, including 4677 uncircumcised and 4416 circumcised boys. Overall effect estimates demonstrate that circumcised boys have significantly reduced odds of developing any UTI [OR 0.26, 95%CI 0.21, 0.32; p < 0.001]]. In addition, there a significantly reduced odds of developing UTI when circumcised and on CAP [OR 0.19, 95% CI 0.13, 0.30; p < 0.001]. When stratifying by etiology, circumcision reduced the odds of UTI in boys with isolated HN [OR 0.33, 95% CI 0.16, 0.68; p = 0.003], vesicoureteral reflux [OR 0.23, 95% CI 0.13, 0.42; P < 0.00001], or with posterior urethral valves [OR 0.29, 95% CI 0.13, 0.64; p = 0.002].

Discussion: Circumcision reduces the incidence of UTIs in boys with antenatal HN. This review is limited by the varied definitions of UTIs and inconsistent reporting on HN etiology, renal outcomes, and circumcision complications.

Conclusions: Circumcision should be considered in boys with antenatal HN to prevent the risk of developing UTI. Further research is warranted to individualize the prophylactic role of circumcision for patients with HN.

Keywords: Antenatal hydronephrosis; Circumcision; Urinary tract infections.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Child
Circumcision, Male* / adverse effects
Female
Humans
Hydronephrosis* / complications
Hydronephrosis* / epidemiology
Kidney
Male
Pregnancy
Risk Factors
Urinary Tract Infections* / epidemiology
Urinary Tract Infections* / etiology
Urinary Tract Infections* / prevention & control