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Year : 1999  |  Volume : 15  |  Issue : 1  |  Page : 73-74

Cohort study on circumcision of newborn boys and subsequent risk of urinary tract infection.


Department of Urology & Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow-226014

Correspondence Address:
H SGT Rao
Department of Urology & Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow-226014

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Source of Support: None, Conflict of Interest: None


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This population-based cohort study followed neonates in Ontario, Canada, prospectively to study the relation between circumcision and subsequent UTI risk. Eligible boys were born to residents of Ontario between April 1, 1993 and March 31, 1994. Hospital discharge data was used to follow-up boys until March 31, 1996. Computerised data from the Canadian Institute for Health Information of hospital discharges in Ontario were used for fiscal years 1993-94 to 1995-96 (April 1 to March 31 of the following year). Data are collected on all patients discharged from public, private and federal hospitals in Ontario, including acute-care and chronic-care hospitals and acute psychiatric hospitals. Therefore, all UTIs that necessitated hospital admission were included in this study. The data-base includes, for each patient on each hospital stay, demographic (birth date, sex and place of residence) and clinical data (admission date, discharge date, length of stay, codes from the International Classification of Diseases, 9th revision for discharge diagnoses). The cohort consisted of initially healthy infants. Multiple births were excluded from this study. Children circumcised after the first month of life were also excluded (2.9 percent). None of these children developed subsequent UTI during the 2-3 years of observation. Each child was followed up from birth to the first occurrence of UTI or to the end of March, 1996. The main outcome measure was hospital admission for UTI. The authors used ICD-9 codes to define UTI-infections of the kidneys (590), cystitis (595), urethritis (597), and other unspecified UTI (599). Cases of UTI necessitating hospital admission generally represent the most severe of the broad range of UTIs and are thus most relevant with respect to the balance of harm and benefit in terms of both cost and morbidity. Life-table method was used to calculate the cumulative probability of hospital admission for UTI, the log-rank statistic was used to compare the cumulative probabilities between the two cohorts, and Cox proportional-hazards regression to model the risks of hospital admission for UTI. Cases of UTI not resulting in hospital admission were not captured in this study. All data analyses were done with SAS software (version 6.11). Of 69100 eligible boys, 30105 (43.6 percent) were circumcised and 38995 (56.4 percent) uncircumcised. 888 boys circumcised after the first month of life were excluded. 29217 uncircumcised boys were matched to the remaining circumcised boys by date of birth. The 1 year probabilities of hospital admission for UTI were 1.88 per 1000 person years of observation (83 cases up to end of follow-up) in the uncircumcised cohort (p0.0001). The estimated relative risk of admission for UTI by first-year follow-up indicated a significantly higher risk for uncircumcised boys than for circumcised boys (3.7 [2.8-4.9]). 195 circumcisions would be needed to prevent one hospital admission for UTI in the first year of life.


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