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.

中文翻译：

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后尿道瓣膜男孩的包皮环切术和发热性尿路感染的风险：CIRCUP 随机试验的结果

背景

患有后尿道瓣膜 (PUV) 的男孩患发热性尿路感染 (fUTI) 的风险增加。包皮环切术被认为可以降低男孩患 fUTI 的风险，尽管没有随机试验证明这一点。

客观的

确定包皮环切术对 PUV 男孩患 fUTI 风险的影响。

设计、设置和参与者

2012 年 8 月至 2017 年 7 月期间进行了一项临床随机试验。该试验是多中心的，包括 13 个儿科泌尿外科转诊中心。男性男孩，年龄 1-28 天，诊断为后尿道瓣膜，经排尿膀胱造影证实。排除标准包括生殖器畸形的存在禁忌进行包皮环切术。

干涉

参与者被随机分配到新生儿包皮环切术 + 抗生素预防 (CATB) 或单独抗生素预防 (ATB)，并随访 2 年。

结果测量和统计分析

主要结果是每组出现 fUTI 的风险。fUTI 被定义为发烧 (>38.5 °C)，伴有脓尿证据和通过尿道插管或耻骨上抽吸获得的尿液培养证实的感染。使用 Kaplan-Meier 方法对主要结局进行双变量分析。

结果和局限性

总共包括 91 名患者：CATB 组 49 名，ATB 组 42 名。ATB 组出现 fUTI 的概率为 20%，而 CATB 组为 3%。与 CATB 组相比，ATB 组在 2 年内出现 fUTI 的风险比为 10.3（95% 置信区间：1.3–82.5）。64 名儿童 (70.3%) 在 2 岁时接受了完整的随访。

结论

包皮环切显着降低了患有 PUV 的男孩出现 fUTI 的风险。

患者总结

在这份报告中，我们在一项多中心试验中比较了仅接受抗生素预防或抗生素预防和包皮环切术的后尿道瓣膜男孩的发热性尿路感染 (UTI) 的数量。我们发现接受过包皮环切术的人患发热性尿路感染的风险明显较低。