Luke Harper1, T Blanc2, M Peycelon3, J L Michel4, M D Leclair5, S Garnier6, V Flaum7, A P Arnaud8, T Merrot9, E Dobremez10, A Faure9, L Fourcade11, M L Poli-Merol12, Y Chaussy13, O Dunand14, F Collin15, L Huiart15, C Ferdynus16, F Sauvat4. 1. Department of Pediatric Surgery, CHU de La Réunion, Saint Denis de La Réunion, France; Department of Pediatric Surgery and Urology, University Hospital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux, France. Electronic address: Harper_luke@hotmail.com. 2. Department of Pediatric Surgery and Urology, APHP, Hôpital Necker, Paris, France. 3. Department of Pediatric Urology, University Hospital Robert Debre, APHP, University of Paris, Centre de Référence des Malformations Rares des Voies Urinaires (MARVU), Paris, France. 4. Department of Pediatric Surgery, CHU de La Réunion, Saint Denis de La Réunion, France. 5. Department of Pediatric Surgery and Urology, Children's University Hospital, CHU de Nantes, Nantes, France. 6. Department of Pediatric Surgery and Urology, Lapeyronie University Hospital, CHU de Montpellier, Montpellier, France. 7. Department of Pediatric Surgery, Armand Trousseau Children's University Hospital, Paris, France. 8. Department of Pediatric Surgery, Rennes University Hospital, CHU de Rennes, Rennes, France. 9. Department of Pediatric Surgery, North and Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, Marseille, France. 10. Department of Pediatric Surgery and Urology, University Hospital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux, France. 11. Department of Pediatric Surgery, University Hospital, CHU de Limoges, Limoges, France. 12. Department of Pediatric Surgery, Reims University Hospital, Reims, France. 13. Department of Pediatric Surgery, Besançon University Hospital, CHU de Besançon, Besançon, France. 14. Department of Pediatric Nephrology, CHU de La Réunion, Saint-Denis de La Réunion, France. 15. Clinical Research Department, INSERM, CIC1410, CHU de la Réunion, Saint-Pierre, France. 16. Clinical Research Department, INSERM, CIC1410, CHU de la Réunion, Saint-Pierre, France; Unité de Soutien Méthodologique, CHU de La Réunion, Saint-Denis de La Réunion, France.
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.
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.