📃 Paper Title: Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomized trials and observational studies
🧍 Author: D Singh-Grewal
🕒 Year: 2004
📚 Journal: Archives of Disease in Childhood
🌎 Country: Australia
ㅤContext to the study:
Can you tell me about a meta-analysis that shows circumcision reduces the risk of UTI in boys who have a history of recurrent UTI or vesicoureteric reflux?
ㅤ✅ Take-home message of study:
This meta-analysis shows circumcision reduces the risk of UTI in boys who have a history of recurrent UTI or vesicoureteric reflux. The data does not support the routine circumcision of normal boys to prevent UTI.
ㅤ Meta-analysis using EMBASE and MEDLINE databases.
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Study participants:
Number of studies included: 12 studies
1 RCT, 4 cohort studies and 7 case-control studies
Inclusion criteria:
All studies examining effect of male circumcision on UTI were initially included
Males without any age restrictions
Only studies that included sufficient information to construct a 2x2 contingency table for OR calculations were included.
Exclusion criteria
Cost-benefit analysis studies, reviews, position statements
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Key study outcomes:
Across the 12 studies, circumcision was associated with a significantly reduced risk of UTI (OR=0.13, 95% 0.08-0.2); p<0.001).
Odds of UTI in circumcised boys are about 0.1 when compared with uncircumcised boys. This represents a reduction in odds of nearly 90%.
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Study Limitations:
Dominated by observational studies - only 1 RCT included
The one RCT included has a small sample size and did not show independent statistical significance.
Variable UTI definitions were used for the 7 case-control and 4 cohort studies
Exclusion criteria and adjustment for confounding were variable between studies.
Only one study followed up patients beyond one year.
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