According to the study, researchers in Washington said Circumcision is associated with a significantly lower rate urinary tract infection (UTI) among infant boys with hydronephrosis

Dr. John Ellison of Seattle Children's Hospital analyzed outcomes of 5,561 infant boys with hydronephrosis, including 2,386 (43%) who underwent newborn circumcision by four weeks of age and 3,175 (57%) who remained uncircumcised.

They also studied 11,120 healthy baby boys, of whom 52% were circumcised by four weeks of age. As reported online June 7 in Pediatrics, the median age at circumcision was 2 days among healthy boys and 9 days among boys with hydronephrosis.

Less than one percent of boys with hydronephrosis underwent circumcision at the time of surgery to correct hydronephrosis. Antibiotic prophylaxis was given to 3.7% of boys with hydronephrosis, with similar rates of use among circumcised and uncircumcised infants.

By the time they were a year old, UTIs had occurred in 12% of boys with hydronephrosis and 1% of healthy boys. On multivariate analysis, circumcision was associated with a significantly decreased risk of UTI both for boys with hydronephrosis (OR 0.36) and those without (OR 0.32). To prevent one UTI, 10 boys with hydronephrosis would need to undergo circumcision compared with 83 healthy boys.

Reduced risk of UTI

Among specific hydronephrosis diagnoses, circumcision was associated with a reduced risk of UTI for boys with isolated hydronephrosis (OR 0.35), vesicoureteral reflux (OR 0.35), and ureteropelvic junction obstruction (OR 0.35).

"Our work highlights the importance of discussing circumcision during the prenatal period for expectant parents," Dr. Ellison told Reuters Health by email. "However, this work highlights associations where the cause cannot be fully defined. Therefore, we recommend families follow the guidance of the American Academy of Pediatrics in placing the greatest weight on parental preference when making this decision."

Dr. Craig Peters, Chief, Pediatric Urology at Children's Health in Dallas and a professor at UT Southwestern, told Reuters Health, "There does seem to be a significant reduction in the risk of UTI with circumcision in those boys. We need to be careful about assuming that all boys with hydronephrosis should be circumcised, however."

"There is great variation in the severity of hydronephrosis and the causes," he said. "The authors were able to separate out some basic diagnoses, but not the severity of the different conditions. The severity is associated with the risk of UTI, so it may be that the benefit of circumcision is limited only to those with the more severe forms of the condition." Use of preventive antibiotics, he added, "can be a low-risk way to reduce infection without having a circumcision."