MP70-03: The Role of Circumcision in Preventing Urinary Tract Infections in Children with Antenatal Hydronephrosis: Systematic Review and Meta-Analysis
Introduction: Circumcision has been reported to reduce the risk of urinary tract infection (UTI) in boys with congenital urinary tract anomalies, a diverse group of conditions that includes hydronephrosis. Our aim was to specifically compare the rates of UTIs in circumcised vs. uncircumcised boys with antenatal hydronephrosis by conducting a systematic review and meta-analysis. Methods: A comprehensive search was performed until December 2021. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed measures included UTIs, continuous antibiotic prophylaxis (CAP) use, renal function, development of cortical scarring, as well as circumcision complications. Odds ratios (OR) and mean difference with 95% confidence interval (CI) were extrapolated from available data. Random-effects meta-analysis were performed, and confounders were assessed with subgroup analysis. Results: Sixteen studies describing 7,503 boys with antenatal hydronephrosis were identified, including 4,116 boys who were uncircumcised and 3,387 boys who were circumcised. The median follow-up time was 24.0 months (range: 6.0 - 152.4 months). Uncircumcised and circumcised boys were found to have UTI rates of 19.1% and 6.1%, respectively. This translates to a number needed to treat (NNT) of 8. Overall effect estimates demonstrate that circumcised boys have a significantly reduced odds of developing any UTI [OR 0.23, 95% CI 0.17, 0.31; p < 0.001]. Furthermore, there was a significantly reduced odds of developing UTI on CAP [OR 0.18, 95% CI 0.11, 0.32; p < 0.001]. When stratifying by etiology of antenatal hydronephrosis, circumcision reduced the odds of UTI in boys with vesicoureteral reflux [OR 0.24, 95% CI 0.12, 0.47; P<0.00001], or posterior urethral valve [OR 0.29, 95% CI 0.13, 0.64; p=0.002]. Long term renal function, development of renal scarring, and postoperative complications were not consistently reported, which prohibited pooling. Most studies had moderate risk of bias. Conclusions: Current evidence suggests that circumcision reduces the frequency of UTIs in boys with antenatal hydronephrosis. Based on these findings, circumcision should be considered in boys with antenatal hydronephrosis to prevent the risk of developing UTI. Further research is warranted to individualize the prophylactic role of circumcision for patients with different etiologies and grade of hydronephrosis. SOURCE OF Funding: None
