Skip to main content

Advertisement

SpringerLink
Log in

The prevalence of vesicoureteral reflux in infants with first urinary tract infection following circumcision is similar to infants with UTI not following circumcision

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

Urinary tract infections (UTIs) are common serious bacterial infections in early infancy. Ritual circumcision in neonates may increase the risk of UTI within 2 weeks of the procedure. The aims of this study were to assess the prevalence and risk factors for vesicoureteral reflux (VUR) among young infants with first UTI following circumcision, and compare it with the prevalence of VUR among young infants with first UTI not related to circumcision.

Methods

In this retrospective cohort study, the medical records of all children aged 0–100 days who were diagnosed with UTI at Shaare Zedek Medical Center between 2005 and 2012 were reviewed for demographic, clinical and laboratory data and for the presence of VUR in voiding cystourethrography (VCUG).

Results

Four hundred and sixty eight cases of UTI were included. Infants with post-circumcision UTI in our study were more likely to have associated bacteremia and abnormal renal function tests. VCUG was done for 166 infants (35%). There was no statistically significant difference in the prevalence of abnormal VCUG between infants with UTI following circumcision, in comparison to infants with UTI not following circumcision (30% vs. 36%, p = NS).

Conclusions

The decision regarding the need for radiographic evaluation and prophylactic antibiotic treatment following UTI should be made regardless if infection was related to circumcision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Prais D, Shoov-Furman R, Amir J (2009) Is ritual circumcision a risk factor for neonatal urinary tract infections? Arch Dis Child 94:191–194

    Article  CAS  Google Scholar 

  2. Wiswell TE, Smith FR, Bass JW (1985) Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics 75:901–903

    PubMed  CAS  Google Scholar 

  3. Cohen HA, Drucker MM, Vainer S et al (1992) Post circumcision urinary tract infection. Clin Pediatr (Phila). 31:322–324

    Article  CAS  Google Scholar 

  4. Schwartz S, Raveh D, Toker O et al (2009) A week-by-week analysis of the low-risk criteria for serious bacterial infection in febrile neonates. Arch Dis Child 94:287–292

    Article  CAS  Google Scholar 

  5. Representatives L (1999) Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 103:843–852

    Article  Google Scholar 

  6. Roberts KB, Revised AAP (2012) Guideline on UTI in febrile infants and young children. Am Fam Physician 86:940–946

    PubMed  Google Scholar 

  7. Roberts KB, Downs SM, Finnell SM et al (2011) Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 128:595–610

    Article  Google Scholar 

  8. Wiswell TE, Geschke DW (1989) Risks from circumcision during the first month of life compared with those for uncircumcised boys. Pediatrics 83:1011–1015

    PubMed  CAS  Google Scholar 

  9. Wiswell TE, Enzenauer RW, Holton ME, Cornish JD, Hankins CT (1987) Declining frequency of circumcision: implications for changes in the absolute incidence and male to female sex ratio of urinary tract infections in early infancy. Pediatrics 79:338–342

    PubMed  CAS  Google Scholar 

  10. Ellison JS, Dy GW, Fu BC, Holt SK, Gore JL, Merguerian PA (2018) Neonatal circumcision and urinary tract infections in infants with hydronephrosis. Pediatrics 142:e20173703

    Article  Google Scholar 

  11. Schoen EJ, Colby CJ, Ray GT (2000) Newborn circumcision decreases incidence and costs of urinary tract infections during the first year of life. Pediatrics 105:789–793

    Article  CAS  Google Scholar 

  12. Amir J, Varsano I, Mimouni M (1986) Circumcision and urinary tract infection in infants. Am J Dis Child 140:1092

    PubMed  CAS  Google Scholar 

  13. Toker O, Schwartz S, Segal G, Godovitch N, Schlesinger Y, Raveh D (2010) A costly covenant: ritual circumcision and urinary tract infection. Isr Med Assoc J 12:262–265

    PubMed  Google Scholar 

  14. American Academy of Pediatrics Task Force on Circumcision (2012) Circumcision policy statement. Pediatrics 130:585–586

    Article  Google Scholar 

  15. Zorc JJ, Levine DA, Platt SL, Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics et al (2005) Clinical and demographic factors associated with urinary tract infection in young febrile infants. Pediatrics 116:644–648

    Article  Google Scholar 

  16. Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S (2012) Routine neonatal circumcision for the prevention of urinary tract infections in infancy. Cochrane Database Syst Rev. 11:CD009129

    PubMed  Google Scholar 

  17. Hallett RJ, Pead L, Maskell R (1976) Urinary infection in boys. A three-year prospective study. Lancet 2:1107–1110

    Article  CAS  Google Scholar 

  18. Cleper R, Krause I, Eisenstein B, Davidovits M (2004) Prevalence of vesicoureteral reflux in neonatal urinary tract infection. Clin Pediatr (Phila) 43:619–625

    Article  Google Scholar 

  19. Drew JH, Acton CM (1976) Radiological findings in newborn infants with urinary infection. Arch Dis Child 51:628–630

    Article  CAS  Google Scholar 

  20. White RH (1989) Vesicoureteric reflux and renal scarring. Arch Dis Child 64:407–412

    Article  CAS  Google Scholar 

  21. Shaikh N, Spingarn RB, Hum SW (2016) Dimercaptosuccinic acid scan or ultrasound in screening for vesicoureteral reflux among children with urinary tract infections. Cochrane Database Syst Rev. 7:CD01657

    Google Scholar 

  22. Juliano TM, Stephany HA, Clayton DB, Thomas JC, Pope JC 4th, Adams MC, Brock JW 3rd, Tanaka ST (2013) Incidence of abnormal imaging and recurrent pyelonephritis after first febrile urinary tract infection in children 2 to 24 months old. J Urol 190:1505–1510

    Article  Google Scholar 

  23. Oostenbrink R, van der Heijden AJ, Moons KG, Moll HA (2000) Prediction of vesico-ureteric reflux in childhood urinary tract infection: a multivariate approach. Acta Paediatr 89:806–810

    Article  CAS  Google Scholar 

Download references

Funding

The study received no funding.

Author information

Authors and Affiliations

  1. Pediatric Department and Infectious Diseases Unit, Shaare Zedek Medical Center Affiliated with Hebrew University-Hadassah School of Medicine, P.O.B. 3235, Jerusalem, Israel

    Orli Megged

  2. Hadassah School of Medicine, Jerusalem, Israel

    Yehonatan Koriat

Authors
  1. Orli Megged
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yehonatan Koriat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Orli Megged.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Megged, O., Koriat, Y. The prevalence of vesicoureteral reflux in infants with first urinary tract infection following circumcision is similar to infants with UTI not following circumcision. Int Urol Nephrol 52, 417–422 (2020). https://doi.org/10.1007/s11255-019-02352-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-019-02352-6

Keywords

Search

Navigation