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BACKGROUND: Boys with urinary tract abnormalities may derive a greater benefit from abstract
newborn circumcision for prevention of urinary tract infection (UTI) than the general
population. However, the effect of newborn circumcision on UTI is not well characterized
across the etiological spectrum of hydronephrosis. We hypothesized that boys with an early
diagnosis of hydronephrosis who undergo newborn circumcision will have reduced rates of
UTI.
METHODS: The MarketScan data set, an employer-based claims database, was used to identify
boys with hydronephrosis or hydronephrosis-related diagnoses within the first 30 days
of life. The primary outcome was the rate of UTIs within the first year of life, comparing
circumcised boys with uncircumcised boys and adjusting for region, insurance type, year of
birth, and infant comorbidity.
RESULTS: A total of 5561 boys met inclusion criteria, including 2386 (42.9%) undergoing
newborn circumcision and 3175 (57.1%) uncircumcised boys. On multivariate analysis,
circumcision was associated with a decreased risk of UTI in both boys with hydronephrosis
and healthy cohorts: odds ratio (OR) 0.36 (95% confidence interval [CI] 0.29–0.44) and OR
0.32 (95% CI 0.21–0.48), respectively. To prevent 1 UTI, 10 patients with hydronephrosis
would have to undergo circumcision compared with 83 healthy boys. Among specific
hydronephrosis diagnoses, circumcision was associated with a reduced risk of UTI for those
with isolated hydronephrosis (OR 0.35 [95% CI 0.26–0.46]), vesicoureteral reflux (OR 0.35
[95% CI 0.23–0.54]), and ureteropelvic junction obstruction (OR 0.35 [95% CI 0.20–0.61]).
CONCLUSIONS: Newborn circumcision is associated with a significantly lower rate of UTI among
infant boys with hydronephrosis.
780.6 (fever) or 788.1 (dysuria), comorbid health problems as 0 to life compared with 34% of those
plus antibiotic prescription within 1 or ≥2 comorbidities. The number with hydronephrosis. The median
3 days before and 5 days after UTI needed to treat (NNT) was calculated age for healthy boys and boys
visit. To ensure no confounding with as the inverse of the risk difference with hydronephrosis undergoing
concomitant surgical procedures for between uncircumcised and circumcision was 2 and 9 days of
correction of hydronephrosis, we circumcised boys. Among boys with life, respectively (P < .01). Only
assessed rates of surgical correction hydronephrosis, odds ratios (ORs) 0.8% of boys with hydronephrosis
at the same time as circumcision and NNT were calculated for the underwent circumcision at the time
as well, by using CPT codes as group overall as well as for specific of surgery to correct hydronephrosis.
previously reported (Dy et al7). hydronephrosis diagnoses. Statistical Antibiotic prophylaxis was noted in
analysis was performed by using 3.7% of boys with hydronephrosis,
Statistical Analysis SAS version 9.4 (SAS Institute, Inc, distributed equally among
Cary, NC). circumcised (89, 3.7%) and
Patient characteristics of circumcised
uncircumcised (119, 3.7%) boys
and uncircumcised boys were
(P = .99).
compared by using χ2 tests. Logistic
RESULTS
regression was used to identify the UTIs occurred in 12% of boys with
association between circumcision We identified 5560 boys with hydronephrosis and 1% of healthy
status and the occurrence of hydronephrosis and 11 120 healthy boys. UTIs were significantly less
UTIs independent of other boys in the study. Circumcision common among circumcised boys
patient demographic and clinical within 28 days was performed in with hydronephrosis compared
characteristics. The adjusted model 43% of boys with hydronephrosis with healthy cohorts (Fig 1). On
included year of birth, geographic and 52% of healthy controls (P < multivariate analysis, circumcision
region, insurance plan type, and .001). Demographic information was associated with a significantly
Elixhauser et al10 comorbidity index. stratified by circumcision status is decreased risk of UTI (OR 0.36 [95%
For the comorbidity index, Elixhauser displayed in Table 1. Among healthy confidence interval (CI) 0.29–0.44]
et al10 conditions were enumerated, boys, 3098 (54%) underwent for boys with hydronephrosis;
and we categorized the burden of circumcision within 2 days of OR 0.32 [95% CI 0.21–0.48] for
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