Login to Access Video or Poster Abstract: MP61-14
Sources of Funding: None

Introduction

Boys with known urinary tract abnormalities may derive a greater benefit of newborn circumcision for prevention of urinary tract infection (UTI) than the general population. However, the effect of newborn circumcision on UTI in this population is not well characterized across the spectrum of etiologies for hydronephrosis (HN). We hypothesized that in boys with an early diagnosis of HN rates of UTI will be reduced by newborn circumcision while patients with vesicoureteral reflux (VUR) and posterior urethral valves (PUV) will realize the greatest benefit of the intervention.

Methods

Claims from MarketScan®, an employer-based dataset of privately insured patients, were used to identify boys with HN or HN-related diagnoses (PUV, VUR, ureteropelvic junction obstruction [UPJO], ureterocele) within the first 30 days of life. Patients with severe urologic comorbidities were excluded as were children with inadequate longitudinal enrollment for follow-up and/or UTI within the first 30 days of life. The primary outcome was the rate of UTIs within the first year of life, comparing circumcised to uncircumcised boys as an entire group and across diagnostic sub-groups, 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. Boys with > 2 comorbidities were more frequently uncircumcised (6.1% vs 2.5%, p < 0.001). Overall rates of UTI were lower in circumcised boys as compared to uncircumcised boys (5.9% vs 16.1%, p < 0.001) with an adjusted odds ratio for a UTI of 0.35 (0.29-0.43) in the circumcised population. Circumcision was associated with a decreased odds of UTI across several diagnostic subgroups including general HN, VUR, and UPJO, as seen in the Table.

Conclusions

Newborn circumcision is associated with a 35% lower rate of UTI in boys with an early diagnosis of HN. This association is seen for across all most diagnostic sub-groups for HN, adjusting for measurable confounding variables. Lack of significant association in boys with PUV and ureterocele may be due to low rates of these diagnosis in this cohort. Future work to prospectively evaluate the benefit of circumcision in this population at a granular level is needed.

Funding

None