Circumcision and Urinary Tract Infections

Summary of Research Results

to be added

Medical Articles and Abstracts

  1. Risk Factors for Febrile Urinary Tract Infection in Children with Prenatal Hydronephrosis: A Prospective Study.
    Braga LH, Farrokhyar F et al
    J Urol. 2015 Mar 23. pii: S0022-5347(14)04772-7. doi: 10.1016

    PURPOSE: We prospectively investigated the impact of risk factors for febrile urinary tract infection in infants with postnatally confirmed prenatal hydronephrosis.
    Patients seen for prenatal hydronephrosis from 2010 to 2013 were prospectively followed. Those with ectopic ureters and ureteroceles, posterior urethral valves and neuropathic bladders were excluded. The primary outcome was febrile catheter specimen urinary tract infection. We performed univariate analysis of 7 a priori risk factors, including age, hydronephrosis grade (low-I or II vs high-III or IV), type (isolated hydronephrosis vs hydroureteronephrosis), continuous antibiotic prophylaxis, vesicoureteral reflux grade, gender and circumcision status. Time to febrile urinary tract infection curves analyzed by Cox proportional regression were generated to adjust for confounders.

    RESULTS: We collected data on 334 patients, of whom 78% were male. A febrile urinary tract infection developed in 65 patients (19%) at a median of 4 months (range 1 to 31). High grade hydronephrosis was present in 192 infants (57%). Continuous antibiotic prophylaxis was prescribed in 96 cases (29%). Of patients on continuous antibiotic prophylaxis 69% had high grade hydronephrosis. Vesicoureteral reflux was identified in 57 of 238 patients in whom voiding cystourethrogram was done. Reflux was grade I to III in 14 cases and grade IV or V in 43. Two-thirds of the patients with reflux were on continuous antibiotic prophylaxis. Circumcision was performed in 95 males (36%). Cox less than 0.01), vesicoureteral reflux (HR 20.8, p less than 0.01) and lack of continuous antibiotic prophylaxis (HR 5.2, less than less than 0.01) as risk factors for febrile urinary tract infection. Subgroup analysis excluding vesicoureteral reflux showed that high grade prenatal hydronephrosis was also a significant risk factor (HR 3.0, p = 0.04).


    After patients with vesicoureteral reflux were excluded from the study, females and uncircumcised males with high grade hydroureteronephrosis had significantly higher febrile urinary tract infection rates. Therefore, those patients may benefit from continuous antibiotic prophylaxis.

    Link to onsite abstract

  2. What is the risk of urinary tract infection in children with antenatally presenting dilating vesico-ureteric reflux?
    Evans K, Asimakadou M et al
    J Pediatr Urol. 2015 Mar 10. pii: S1477-5131(15)00050-9

    The incidence of recurrent urinary tract infection (UTI) in children with primary vesico-ureteric reflux (VUR) presenting symptomatically is well documented. The risk of UTI in asymptomatic primary VUR diagnosed on investigation of antenatal hydronephrosis (ANH) is less clear. Paradoxically, several previous studies have suggested a lower risk (1-25%). We ascertain the incidence of UTI amongst antenatally-presenting primary VUR and explore risk factors.

    STUDY DESIGN: All patients younger than 16 years managed for primary VUR between 1997 and 2013 were retrospectively reviewed. Patients were identified by searching 'VUR, vesicoureteric reflux' and 'vesico' in the clinical database. Sex, follow up, antibiotic prophylaxis, age at UTI, grade of VUR, radioisotope imaging findings (CRN-congenital reflux nephropathy, NRD-new renal defects), evidence of bladder dysfunction, surgical intervention and resolution were recorded. UTI diagnosis was based on positive urine culture with symptoms including fever. SPSS statistical package and Pearson's Chi-squared test were used to explore significance.

    RESULTS: Of 308 patients with primary VUR aged younger than 16 years treated, 242 were diagnosed following presentation with UTI. The remaining 66 (21%) were initially asymptomatic, and VUR was diagnosed on investigation of ANH. All were given prophylaxis from birth. Six months to 16years (median 6years) follow-up was available for 54 (42 males, 12 females). All but two patients had grade III-V VUR (96%), bilaterally in 41 (76%). CRN was evident in 30 (56%; all male) and bladder dysfunction in 12 (22%; 10 males). Twenty-eight patients (52%) developed a UTI. The risk of UTI was 58% in girls, 33% in boys without CRN and 57% in boys with CRN (p = 0.17). Bladder dysfunction was a significant risk factor for UTI (p = 0.03). All 8 (15%; 7 males) with NRD had had a UTI. A single UTI appeared responsible for the majority of NRD (6/8; 75%). UTI occurred in 6/27 (22%) boys after circumcision compared to 17/25 (68%) prior/without circumcision


    The incidence of UTI in VUR detected after presentation with ANH was 52%. CRN and bladder dysfunction were risk factors for developing a UTI. Circumcision appears to significantly reduce the risk of infection. Antenatal presentation of primary VUR does not carry a reduced risk of UTI. A single UTI, in half before the age of six months, seemed responsible for the majority of NRD. In boys, the highest risk of UTI is in the first few months of infancy, despite antibiotic prophylaxis, and other interventions, particularly circumcision, should therefore be considered as early as possible.
    Link to the onsite abstract.

  3. Neonatal urinary tract infection may increase the risk of childhood asthma.
    Lin CH, Wang YC, Lin WC, Kao CH.
    Eur J Clin Microbiol Infect Dis. 2015 Sep;34(9):1773-8. doi: 10.1007/s10096-015-2411-0. Epub 2015 May 24.

    Abstract: Abstract The aim of this population-based retrospective cohort study was to investigate the onset of urinary tract infection in newborns and the associated risks of childhood asthma. Children with neonatal UTI (n?=?3,312) and randomly selected controls (n?=?13,243) were enrolled for our analysis. We calculated the follow-up person-years for each participant from the index date until the diagnosis of asthma, the end of 2008, or withdrawal from the insurance system (because of death or loss to follow-up). Furthermore, we compared the risk of asthma between non-UTI and UTI cohorts by using Cox proportional hazards model analysis, the adjusted hazard ratio (aHR), and a 95 % confidence interval (95 % CI). The overall asthma incidence rate was found to be 1.53-fold significantly higher in the UTI cohort than in the non-UTI cohort (70.3 vs 45.8 per 1000 person-years). After we adjusted for potential risk factors, the overall risk of asthma remained higher in the UTI cohort (aHR?=?1.47, 95 % CI?=?1.35-1.59). The incidence rate was higher in boys than in girls. Overall, patients suffering from UTI may have a greater risk of developing asthma than patients without UTI. This nationwide retrospective cohort study demonstrates that neonatal UTI may increase the risk of childhood asthma. PMID: 26003311 [PubMed - in process]

    Link to the onsite abstract.

  4. Urinary tract infections in the infant.
    Arshad M, Seed PC
    Clin Perinatol. 2015 Mar;42(1):17-28, vii. doi: 10.1016/j.clp.2014.10.003. Epub 2014 Dec 24

    Urinary tract infection (UTI) in an infant may be the first indication of an underlying renal disorder. Early recognition and initiation of adequate therapy for UTI is important to reduce the risk of long-term renal scarring. Ampicillin and gentamicin are traditionally the empiric treatment of choice; however, local antibiotic resistance patterns should be considered. Maternal antibiotics during pregnancy also increase the risk of resistant pathogens during neonatal UTI. Long-term management after the first UTI in infants remains controversial because of lack of specific studies in this age group and the risk-benefit issues for antibiotic prophylaxis between reduced recurrent disease and emergent antibiotic resistance.

    Note: Since newborn male circumcision reduces risk of UTI in infancy by 10-fold this article provides further reasons why prevention of UTI by newborn circumcision is preferable to attempting to cure the condition later.

    Link to the onsite abstract.

Links to further Information

    Circumcised or not, it matters little to sexual partners, study shows
    Male Circumcision Improves Sex for Women.
    Abstract: Women whose male sexual partners were circumcised report an improvement in their sex life, a survey shows.
    Top reasons cited by women for their better sex life: improved hygiene, longer time for their partner to achieve orgasm, and their partner wanting more frequent sex ... Rakai Health Sciences Program in Kalisizo, Uganda.
    Men feel much the same way, he adds. In a previous survey, 97% of men said their level of sexual satisfaction was either unchanged or better after they were circumcised.