Circumcision reduces rate of urinary tract infection especially for high-risk boys.

摘要

Question Does circumcision reduce the risk of urinary tract infection (UTI) in boys?Data Sources Cochrane controlled trials register, MEDLINE, EMBASE, reference lists of retrieved articles, and contact with known investigators.Study Identification and Assessment Randomized controlled trials and observational studies that compared the frequency of UTI in circumcised and uncircumcised boys. Two authors independently assessed study quality using guidelines provided by the CONSORT statement for quality of randomized studies and the MOOSE statement for quality of observational studies.Outcomes Diagnosis with UTI.Main Results Data on 402,908 children were identified from 12 studies (one randomized controlled trial, four cohort studies, and seven case-control studies). Circumcision was associated with a significantly reduced risk of UTI (OR = 0.13; 95% CI, 0.08 to 0.20; p<0.001) with the same odds ratio (0.13) for all three types of study design.Conclusions Circumcision reduces the risk of UTI. Given a risk in normal boys of about 1%, the number needed to treat (NNT) to prevent one UTI is 111. In boys with recurrent UTI or high grade veskoureteric reflux, the risk of UTI recurrence is 10% and 30% and the NNTs are 11 and 4, respectively. Hemorrhage and infection are the most common complications of circumcision, occurring at rate of about 2%. Assuming equal utility of benefits and harms, net clinical benefit is likely only in boys at high risk of UTI.