Effect of circumcision on urinary tract infection after successful antireflux surgery

Abstract

OBJECTIVETo evaluate whether circumcision during antireflux surgery can reduce the incidence of urinary tract infection (UTI) after successful ureteric reimplantation in patients with primary vesico‐ureteric reflux (VUR).PATIENTS AND METHODSChildren who had undergone antireflux surgery for primary VUR were divided into group 1 (27, circumcised at the time of antireflux surgery at the parents’ request) and group 2 (50, those not circumcised). All antireflux operations were by the Cohen method. Regular urine samples were cultured to detect UTI, which was defined as a single species with >105 colony‐forming units/mL in a midstream voided specimen. Numbers of UTI episodes before and after surgery were compared between the groups, with 99mTc‐dimercaptosuccinic acid (DMSA) renal scans also taken in all patients. Each scan was blindly reviewed in terms of the size, number and zonal location of cortical defects, based on morphology. Interval changes were categorised as improved, no change, progressed, and new scar formation, and compared between the groups. Prophylactic antibiotics were maintained until the follow‐up studies at 4–6 months after surgery.RESULTSThere was no significant difference between the groups in age at the time of operation (mean 42.4 vs 47.4 months), the age at the first documented UTI (mean 26.5 vs 29.3 months), reflux grade, or number of UTI episodes and renal parenchymal scarring on DMSA before surgery. There was no significant difference between the groups in the number of UTI episodes at a mean (range) follow‐up of 151.3 (114–207) months after antireflux surgery. Also there was no significant morphological change on follow‐up renal scans and no difference between the groups.CONCLUSIONThese findings suggest that circumcision during antireflux surgery has no effect on the incidence of postoperative UTI.

Neonatal circumcision reduces the incidence of asymptomatic urinary tract infection: A large prospective study with long-term follow up using Plastibell

“…Castellsague et al restricted the absolute indication for circumcision to phimosis secondary to balanitis xerotica obliterans and recurrent balanoposthitis, and elucidated the relative indication of urological abnormalities [16]. Kwak et al demonstrated that circumcision after antireflux surgery in long-term follow up has no significant effect on the number of episodes of postoperative UTI, so they didn't recommend circumcision even in children with vesicoureteral reflux [17].…”

Abridged version: CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants

“…In patients with VUR, circumcision was more effective than antibiotic prophylaxis alone or surgical correction in preventing UTIs and the occurrence of new DMSA abnormalities [23][24][25] . Similar results were seen in boys with posterior urethral valves 26 and infants with significant antenatal hydronephrosis 27 .…”

Çocuklarda sünnetin idrar yolu enfeksiyonu sıklığı üzerine etkisi

“…Reflü cerrahisi ve koruyucu tedavi ile bu amaca ulafl›lmaya çal›fl›l›r (28). Az say›da ça-l›flmada sünnetin reflüsü olan çocuklarda ‹YE s›kl›¤›n› azaltmadaki etkisi de¤erlendirilmifltir (29,30). Cascio ve ark.…”