Circumcision and Risk of Febrile Urinary Tract Infection in Boys with Posterior Urethral Valves: Result of the CIRCUP Randomized Trial
- PMID: 34563412
- DOI: 10.1016/j.eururo.2021.08.024
Circumcision and Risk of Febrile Urinary Tract Infection in Boys with Posterior Urethral Valves: Result of the CIRCUP Randomized Trial
Abstract
Background: Boys with posterior urethral valves (PUVs) have an increased risk of febrile urinary tract infections (fUTIs). Circumcision is believed to reduce the risk of fUTIs in boys, although there are no randomized trials demonstrating this.
Objective: To determine the effect of circumcision on the risk of fUTIs in boys with PUVs.
Design, setting, and participants: A clinical randomized trial that ran between August 2012 and July 2017 was conducted. The trial was multicentric, including 13 referral centers for pediatric urology. Male boys, aged 1-28 d, diagnosed with posterior urethral valves, confirmed by voiding cystogram, were included. The exclusion criteria included presence of a genital malformation contraindicating performing a circumcision.
Intervention: Participants were randomized to neonatal circumcision + antibiotic prophylaxis (CATB) or antibiotic prophylaxis alone (ATB), and followed for 2 yr.
Outcome measurements and statistical analysis: The primary outcome was a risk of presenting fUTIs in each group. An fUTI was defined as fever (>38.5 °C) with evidence of pyuria and culture-proven infection on urinalysis, obtained by urethral catheterization or suprapubic aspiration. A bivariate analysis of the primary outcome was performed using the Kaplan-Meier method.
Results and limitations: In total, 91 patients were included: 49 in group CATB and 42 in group ATB. The probability of presenting an fUTI was 20% in group ATB versus 3% in group CATB. The hazard ratio of presenting an fUTI within 2 yr in the ATB group compared with that in the CATB group was 10.3 (95% confidence interval: 1.3-82.5). Sixty-four children (70.3%) had a complete follow-up at 2 yr of age.
Conclusions: Circumcision significantly decreases the risk of presenting an fUTI in boys with PUVs.
Patient summary: In this report, we compared, in a multicentric trial, the number of febrile urinary tract infections (UTIs) in boys with posterior urethral valves who had either antibiotic prophylaxis alone or antibiotic prophylaxis and circumcision. We found that those who had a circumcision had a significantly lower risk of febrile UTIs.
Keywords: Circumcision; Febrile urinary tract infection; Posterior urethral valves; Randomized trial.
Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Comment in
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Address the Foreskin in Newborn Boys with Posterior Urethral Valves, in One Way or Another!Eur Urol. 2022 Jan;81(1):73-74. doi: 10.1016/j.eururo.2021.09.022. Epub 2021 Oct 5. Eur Urol. 2022. PMID: 34625311 No abstract available.
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Reply to Abhay Singh and Prasant Nayak's Letter to the Editor re: Luke Harper, T. Blanc, M. Peycelon, et al. Circumcision and Risk of Febrile Urinary Tract Infection in Boys with Posterior Urethral Valves: Result of the CIRCUP Randomized Trial. Eur Urol. 2022;81:64-72.Eur Urol. 2022 Mar;81(3):e71-e72. doi: 10.1016/j.eururo.2021.11.028. Epub 2021 Dec 7. Eur Urol. 2022. PMID: 34893360 No abstract available.
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Re: Luke Harper, T. Blanc, M. Peycelon, et al. Circumcision and Risk of Febrile Urinary Tract Infection in Boys with Posterior Urethral Valves: Result of the CIRCUP Randomized Trial. Eur Urol. 2022;81:64-72.Eur Urol. 2022 Mar;81(3):e73. doi: 10.1016/j.eururo.2021.11.031. Epub 2021 Dec 18. Eur Urol. 2022. PMID: 34933755 No abstract available.
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Reply to Deepansh Dalela and Kristina Suson's Letter to the Editor re: Luke Harper, T. Blanc, M. Peycelon, et al. Circumcision and Risk of Febrile Urinary Tract Infection in Boys with Posterior Urethral Valves: Result of the CIRCUP Randomized Trial. Eur Urol. 2022;81:64-72.Eur Urol. 2022 Mar;81(3):e74. doi: 10.1016/j.eururo.2021.12.001. Epub 2021 Dec 20. Eur Urol. 2022. PMID: 34937678 No abstract available.
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Re: Luke Harper, T. Blanc, M. Peycelon, et al. Circumcision and Risk of Febrile Urinary Tract Infection in Boys with Posterior Urethral Valves: Result of the CIRCUP Randomized Trial. Eur Urol. 2022;81:64-72.Eur Urol. 2022 Mar;81(3):e70. doi: 10.1016/j.eururo.2021.11.027. Epub 2021 Dec 31. Eur Urol. 2022. PMID: 34980494 No abstract available.
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Pediatric Urology.J Urol. 2022 Dec;208(6):1335-1337. doi: 10.1097/JU.0000000000002990. Epub 2022 Oct 4. J Urol. 2022. PMID: 36194658 No abstract available.
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