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Circumcision in infants with hydronephrosis tied to lower UTI risk
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Infant boys with hydronephrosis who received newborn circumcision had a significantly decreased risk of urinary tract infections, according to recently published research in Pediatrics.
“Hydronephrosis, often discovered antenatally, is a common newborn diagnosis that impacts 1% to 3% of all live births,” Jonathan S. Ellison, MD, assistant professor of urology at Seattle Children’s Hospital, and colleagues wrote. “Boys with hydronephrosis are at an increased risk of urinary tract infections (UTIs), especially early in life. Circumcision is known to provide a small yet significant risk reduction of early UTIs in healthy boys.”
Ellison and colleagues identified boys diagnosed with hydronephrosis or a hydronephrosis-related diagnosis within the first 30 days of life by using MarketScan, an employer-based claims database. Researchers compared UTI rates within the first year of life between circumcised boys and uncircumcised boys — the study’s primary outcome. Geographic region of care, insurance type, year of birth and infant comorbidity also were included.
The study included 5,560 boys aged younger than 1 year with hydronephrosis within the first month of life and 11,120 healthy boys of the same age range. According to the researchers, 42.9% of boys with hydronephrosis and 51.9% of healthy controls underwent circumcision within 28 days. There was an association between circumcision and a significantly decreased risk for UTI in boys with hydronephrosis (OR = 0.36; 95% CI, 0.29-0.44) and healthy boys (OR = 0.32; 95% CI, 0.21-0.48), they found.
There was an occurrence of UTIs in 12% of boys with hydronephrosis, compared with 1% of the healthy cohort. Ten boys with hydronephrosis would need to undergo circumcision, compared with 83 healthy boys, to prevent one UTI, the researchers said.
Among specific hydronephrosis diagnoses, there were associations between circumcision and a reduced risk for UTI in boys with isolated hydronephrosis (OR = 0.35; 95% CI, 0.26-0.46), vesicoureteral reflux (OR = 0.35; 95% CI, 0.23-0.54) and ureteropelvic junction obstruction (OR = 0.35; 95% CI, 0.2-0.61) when compared with uncircumcised boys.
“In this nationally representative sample of insured children, circumcision was associated with a significantly decreased risk for UTI among both healthy boys and those with a diagnosis of hydronephrosis in infancy,” the researchers wrote.
“The associated benefit of newborn circumcision was greater for boys with hydronephrosis than healthy controls,” Ellison and colleagues concluded. “Importantly, this associative benefit was consistent across different underlying hydronephrosis diagnoses. These results are hypothesis generating and may guide future prospective studies for this population.” – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.
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