Effect of circumcision on urinary tract infection after successful antireflux surgery

Abstract

OBJECTIVE

To evaluate whether circumcision during antireflux surgery can reduce the incidence of urinary tract infection (UTI) after successful ureteric reimplantation in patientswith primary vesico-ureteric reflux (VUR).

PATIENTS AND METHODS

Children who had undergone antireflux surgery for primary VUR were divided into group 1 (27, circumcised at the time of antireflux surgery at the parents request) and group 2 (50, those not circumcised). All antireflux operations were by the Cohen method. Regular urine samples were cultured to detect UTI, which was defined as a single species with >10⁵ colony-forming units/mL in a midstream voided specimen. Numbers of UTI episodes before and after surgery were compared between the groups, with ^99mTcdimercaptosuccinic acid (DMSA) renal scans also taken in all patients. Each scan was blindly reviewed in terms of the size, number and zonal location of cortical defects, based on morphology. Interval changes were categorised as improved, no change, progressed, and new scar formation, and compared between the groups. Prophylactic antibiotics were maintained until the followup studies at 4–6 months after surgery.

RESULTS

There was no significant difference between the groups in age at the time of operation (mean 42.4 vs 47.4 months), the age at the first documented UTI (mean 26.5 vs 29.3 months), reflux grade, or number of UTI episodes and renal parenchymal scarring on DMSA before surgery. There was no significant difference between the groups in the number of UTI episodes at a mean (range) follow-up of 151.3 (114–207) months after antireflux surgery. Also there was no significant morphological change on followup renal scans and no difference between the groups.

CONCLUSION

These findings suggest that circumcision during antireflux surgery has no effect on the incidence of postoperative UTI.

KEYWORDS

circumcision, urinary tract infection, vesicoureteric reflux, outcome