Circumcision and Risk of Febrile Urinary Tract Infection in Boys with Posterior Urethral Valves: Result of the CIRCUP Randomized Trial.

Abstract

BACKGROUND\nBoys 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.\n\n\nOBJECTIVE\nTo determine the effect of circumcision on the risk of fUTIs in boys with PUVs.\n\n\nDESIGN, SETTING, AND PARTICIPANTS\nA 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.\n\n\nINTERVENTION\nParticipants were randomized to neonatal circumcision\xa0+\xa0antibiotic prophylaxis (CATB) or antibiotic prophylaxis alone (ATB), and followed for 2 yr.\n\n\nOUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS\nThe primary outcome was a risk of presenting fUTIs in each group. An fUTI was defined as fever (>38.5\xa0°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.\n\n\nRESULTS AND LIMITATIONS\nIn 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.\n\n\nCONCLUSIONS\nCircumcision significantly decreases the risk of presenting an fUTI in boys with PUVs.\n\n\nPATIENT SUMMARY\nIn 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.