Uncircumcised boys at increased risk for UTI

Although it is widely held that uncircumcised boys are at increased risk for urinary tract infections (UTIs) compared with circumcised boys, researchers from Canada set out to determine whether that increased risk varies with foreskin “tightness” and visibility of the urethral meatus.

The investigators found that, contrary to their hypothesis, risk does not vary much with foreskin retractability and urethral visibility.

Researchers in Montreal conducted a prospective cross-sectional study in a pediatric emergency department that involved 393 young boys with a median age of about 4 months. None of the participants was toilet trained, and all were catheterized for urine culture at the request of their treating physicians.

Among the patients included in the study, 309 were uncircumcised, a high but expected amount given that uncircumcised boys are more likely to get UTIs, and this was a population of boys suspected of having a UTI.

The investigators found that almost one-third (30%) of the uncircumcised boys with a completely visible meatus had a UTI, as did almost one-fourth (23.8%) of the uncircumcised boys with a partially visible or nonvisible meatus, versus 4.8% of the circumcised boys.

The boys with a partially visible or nonvisible meatus were less than half as likely to have a UTI as those with a completely visible meatus. The researchers had thought that those with a “tight” foreskin with incomplete retractability would be at higher risk of infection.

Generally speaking, uncircumcised boys are about 10 times as likely to get a UTI as circumcised boys, but absolute risk is still very low.

Although the American Academy of Pediatrics does not recommend for or against circumcision in its policy statement, it recently suggested in a technical report that circumcision status be used to select which boys should be evaluated for UTI.

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