Concealed Penis after Circumcision: Is It Beneficial in Lowering Uropathogenic Colonization in Penile Skin and Preventing Recurrence of Febrile Urinary Tract Infections?
Vol. 17 No. 2 (2020),
16 March 2020
AbstractPurpose: To discuss whether concealed penis after circumcision lowers perimeatal urethral and glanular sulcus uropathogenic bacterial colonization in healthy boys with no urinary tract problems and prevents attacks of febrile urinary tract infections in non-healthy boys with defined urinary tract abnormalities.
Materials and Methods: This case-control study was conducted in Ibn-i Sina Hospital and retrospectively collected data of 471 boys were analyzed. All patients were scanned for any urinary tract abnormality and those with any defined abnormalities were classified as non-healthy group. (123 patients) Non-healthy patients were divided into two subgroups as concealed (n:31) and non-concealed (n:92) penis after circumcision. Healthy patients with no urinary problems were divided into three groups as circumcised without concealed penis (n:144), with concealed penis after circumcision (n:104) and uncircumcised control group (n:100). Bacterial cultures were obtained from both periurethral meatal and glanular sulcus areas by adhering strictly to the rules of obtaining bacterial culture to avoid false-positive or negative culture results. Also only uropathogenic bacterias were evaluated, irrelevant results were excluded.
Results: Mean age was similar in healthy population. Comparison of three groups showed that there was a significant difference in both cultures.(P = .026 for periurethral meatal region, P = .039 for glanular sulcus region) In post hoc analysis, non-concealed group had a lower rate of culture positivity in both areas compared to other groups. Mean age was also similar in non-healthy population. Mean follow-up period was 18.2 months. Patients with concealed penis after circumcision had a significantly higher number of febrile UTI attacks (20 attacks in 8 patients vs 7 attacks in 5 patients) compared to non-concealed group. (P = .019) All febrile UTI attacks except one in this group occurred below the age of 12 months. A total of 10 patients in both healthy and non-healthy groups had postoperative hemorrhage after circumcision and only 1 patient had a wound infection.
Conclusion: Concealed penis after circumcision does not lower perimeatal urethral and glanular sulcus uropathogenic bacterial colonization in healthy patients and does not protect unhealthy patients from febrile urinary tract infection attacks. If circumcision is planned, concealed penis should be avoided and also parents should be informed about the possible risks due to concealed penis before the procedure, particularly in patients with urinary tract abnormalities.
- Tewary K, Narchi H. Recurrent urinary tract infections in children: Preventive interventions other than prophylactic antibiotics, World J Methodol. 2015;26:13-19.
- Bader M, McCarthy L. What is the efficacy of circumcision in boys with complex urinary tract abnormalities? Pediatr Nephrol. 2013;28:2267-2272.
- Sorokan ST, Finlay JC, Jefferies AL, Canadian Paediatric Society, Fetus and Newborn Committee, Infectious Diseases and Immunization Committee. Newborn male circumcision, Paediatr Child Health. 2015;20:311-320.
- Na AF, Tanny SP, Hutson JM. Circumcision: Is it worth it for 21st-century Australian boys? J Paediatr Child Health. 2015;51:580-583.
- Wiswell TE, Miller GM, Gelston HM Jr, Jones SK, Clemmings AF. Effect of circumcision status on periurethral bacterial flora during the first year of life. J Pediatr. 1988;113:442-446.
- ICR. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.2013
- Hellerstein S. Urinary tract infections in children: why they occur and how to prevent them. Am Fam Physician. 1998;57:2440-2446, 2452-2454.
- Earp BD. Do the Benefits of Male Circumcision Outweigh the Risks? A Critique of the Proposed CDC Guidelines. Front Pediatr. 2015;3:18.
- Abdulwahab-Ahmed A, Mungadi IA. Techniques of male circumcision. J Surg Tech Case Rep. 2013;5:1-7.
- Gold G, Young S, O'Brien M, Babl FE. Complications following circumcision: Presentations to the emergency department. J Paediatr Child Health. 2015;51:1158-1163.
- Odoyo-June E, Feldblum PJ, Fischer S, Bailey RC, Obiero W, Hart C, Veena V, Combes S, Cherutich P. Unexpected Complications Following Adult Medical Male Circumcision Using the PrePex Device. Urol Int. 2016;96:188-193.
- Demaria J, Abdulla A, Pemberton J, Raees A, Braga LH. Are physicians performing neonatal circumcisions well-trained? Can Urol Assoc J. 2013;7:260-264.
- Steadman B, Ellsworth P. To circ or not to circ: indications, risks, and alternatives to circumcision in the pediatric population with phimosis. Urol Nurs. 2006;26:181-194.
- Gücük A, Burgu B, Gökçe İ, Mermerkaya M, Soygür T. Do antibiotic prophylaxis and/or circumcision change periurethral uropathogen colonization and urinary tract infection rates in boys with VUR? J Pediatr Urol. 2013;6:1131-1136.
- Kose E, Yavascan O, Turan O, Kangin M, Bal A, Alparslan C, Sirin Kose S, Kuyum P, Aksu N. The effect of circumcision on the frequency of urinary tract infection, growth and nutrition status in infants with antenatal hydronephrosis. Ren Fail. 2013;35:1365-1369.
- Abstract Viewed: 443 times
- pdf/5192 Downloaded: 150 times