Do antibiotic prophylaxis and/or circumcision change periurethral uropathogen colonization and urinary tract infection rates in boys with VUR?

Abstract

Background: To evaluate the effect of circumcision and/or antibiotic prophylaxis on periurethral flora and associated bacteriuria in male children with and without vesicoureteral reflux (VUR).

Patients and methods: The study included 91 boys with low-grade VUR and 106 healthy boys (control) without VUR. The boys with VUR were randomized as antibiotic prophylaxis only and antibiotic prophylaxis plus circumcision. The boys without VUR were randomized as circumcision group and followed-up group without circumcision. Periurethral swab and urine cultures were obtained from the participants at the beginning of the study, and at 1st, 3rd, 6th, 9th, and 12th month. The groups were compared in terms of positive periurethral and urine cultures.

Results: The positive periurethral culture rate was significantly lower in the circumcised boys at all measurement times. The positive urine culture rate in the circumcised boys was lower than in the uncircumcised boys. Subgroup analysis based on age groups showed that age did not affect these statistical differences.

Conclusion: Circumcision decreases colonization of periurethral bacterial pathogenic flora. In boys with low-grade VUR, circumcision plus antibiotic prophylaxis prevented recurrent and febrile urinary tract infections.

Keywords: Periurethral flora; Prophylaxis; Urinary tract infection; Urine culture rate; Vesicoureteral reflux.