Wang Hui,Xie Hua,Kang Yulin,et al.Effect of circumcision or continuous antibiotic prophylaxis on lowering the recurrence rate of febrile urinary tract infection in boys with primary vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,,21():1057-1061.[doi:10.3760/cma.j.cn101785-202207053-011]
Effect of circumcision or continuous antibiotic prophylaxis on lowering the recurrence rate of febrile urinary tract infection in boys with primary vesicoureteral reflux
- Keywords:
- Vesico-Ureteral Reflux; Child; Circumcision; Male; Antibiotic Prophylaxis
- Abstract:
- Objective To explore the effect of circumcision and continuous antibiotic prophylaxis on lowering the recurrence rate of febrile urinary tract infection in boys with primary vesicoureteral reflux.Methods From June 2017 to June 2020, clinical data were retrospectively reviewed for 88 boys with primary vesicoureteral reflux.The median age was 10.2(5.9, 17.9) months.They were assigned into four groups of watchful waiting (n=3), continuous antibiotic prophylaxis (n=50), circumcision (n=22) and continuous antibiotic prophylaxis plus circumcision (n=13).The follow-up period was 1 to 3 years.The recurrence of febrile urinary tract infection in each group was recorded and the effective conservative strategy analyzed.Results Among them, there were 21 cases (23.9%) of febrile urinary tract infection recurrence, 2 cases in watchful waiting group, 16 cases in continuous antibiotic prophylaxis group and 3 cases in circumcision group.No recurrence was noted in continuous antibiotic prophylaxis plus circumcision group.Statistical differences existed in recurrence rate among 4 treatment groups (χ2=10.181, P=0.011).Factorial analysis indicated that circumcision was a major factor in lowering the recurrence of febrile urinary tract infections (P=0.003).Conclusion For boys with primary vesicoureteral reflux, circumcision plus continuous antibiotic prophylaxis may prevent the recurrence of febrile urinary tract infection and circumcision plays a major role.No significant difference exists between continuous antibiotic prophylaxis and watchful waiting groups in lowering the recurrence rate of febrile urinary tract infection.
References:
[1] Hewitt I, Montini G.Vesicoureteral reflux is it important to find?[J].Pediatr Nephrol, 2021, 36(4):1011-1017.DOI:10.1007/s00467-020-04573-9.
[2] 中华医学会小儿外科学分会泌尿外科学组.儿童原发性膀胱输尿管反流专家共识[J].临床小儿外科杂志, 2019, 18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002. Group of Pediatric Urology, Branch of Pediatric Surgery, Chinese Medical Association.Expert Consensus on Managing Primary Vesicoureteral Reflux in Children[J].J Clin Ped Sur, 2019, 18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002.
[3] Williams G, Craig JC.Long-term antibiotics for preventing recurrent urinary tract infection in children[J].Cochrane Database Syst Rev, 2019, 4(4):CD001534.DOI:10.1002/14651858.CD001534.pub4.
[4] Peters CA, Skoog SJ, Arant BS Jr, et al.Summary of the AUA guideline on management of primary vesicoureteral reflux in children[J].J Urol, 2010, 184(3):1134-1144.DOI:10.1016/j.juro.2010.05.065.
[5] Thergaonkar RW, Hari P.Current management of urinary tract infection and vesicoureteral reflux[J].Indian J Pediatr, 2020, 87(8):625-632.DOI:10.1007/s12098-019-03099-9.
[6] Omole F, Smith W, Carter-Wicker K.Newborn circumcision techniques[J].Am Fam Physician, 2020, 101(11):680-685.
[7] Yang SS, Tsai JD, Kanematsu A, et al.Asian guidelines for urinary tract infection in children[J].J Infect Chemother, 2021, 27(11):1543-1554.DOI:10.1016/j.jiac.2021.07.014.
[8] Greenfield SP, Carpenter MA, Chesney RW, et al.The RIVUR voiding cystourethrogram pilot study:experience with radiologic reading concordance[J].J Urol, 2012, 188(4 Suppl):1608-1612.DOI:10.1016/j.juro.2012.06.032.
[9] 中华医学会儿科学分会肾脏学组.泌尿道感染诊治循证指南(2016)[J].中华儿科杂志, 2017, 55(12):898-901.DOI:10.3760/cma.j.issn.0578-1310.2017.12.005. Group of Nephrology, Branch of Pediatrics, Chinese Medical Association.Evidence-based Guideline on Diagnosing and Treating Urinary Tract Infection (2016)[J].Chin J Pediatr, 2017, 55(12):898-901.DOI:10.3760/cma.j.issn.0578-1310.2017.12.005.
[10] Subcommittee on Urinary Tract Infection.Reaffirmation of AAP clinical practice guideline:the diagnosis and management of the initial urinary tract infection in febrile infants and young children 2-24 months of age[J].Pediatrics, 2016, 138(6):e20163026.DOI:10.1542/peds.2016-3026.
[11] Miyakita H, Hayashi Y, Mitsui T, et al.Guidelines for the medical management of pediatric vesicoureteral reflux[J].Int J Urol, 2020, 27(6):480-490.DOI:10.1111/iju.14223.
[12] RIVUR Trial Investigators.Antimicrobial prophylaxis for children with vesicoureteral reflux[J].N Engl J Med, 2014, 370(25):2367-2376.DOI:10.1056/NEJMoa1401811.
[13] Skoog SJ, Peters CA, Arant BS Jr, et al.Pediatric vesicoureteral reflux guidelines panel summary report:clinical practice guidelines for screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis[J].J Urol, 2010, 184(3):1145-1151.DOI:10.1016/j.juro.2010.05.066.
[14] Williams G, Hodson EM, Craig JC.Interventions for primary vesicoureteric reflux[J].Cochrane Database Syst Rev, 2019, 2(2):CD001532.DOI:10.1002/14651858.CD001532.pub5.
[15] Brandstr m P, Esbj rner E, Herthelius M, et al.The Swedish reflux trial in children:III.Urinary tract infection pattern[J].J Urol, 2010, 184(1):286-291.DOI:10.1016/j.juro.2010.01.061.
[16] Guidos PJ, Arlen AM, Leong T, et al.Impact of continuous low-dose antibiotic prophylaxis on growth in children with vesicoureteral reflux[J].J Pediatr Urol, 2018, 14(4):325.e1-325.e7.DOI:10.1016/j.jpurol.2018.07.007.
[17] Bertsimas D, Li M, Estrada C, et al.Selecting children with vesicoureteral reflux who are most likely to benefit from antibiotic prophylaxis:application of machine learning to RIVUR[J].J Urol, 2021, 205(4):1170-1179.DOI:10.1097/JU.0000000000001445.
[18] Fussell EN, Kaack MB, Cherry R, et al.Adherence of bacteria to human foreskins[J].J Urol, 1988, 140(5):997-1001.DOI:10.1016/S0022-5347(17)41909-4.
[19] Ellison JS, Dy GW, Fu BC, et al.Neonatal circumcision and urinary tract infections in infants with hydronephrosis[J].Pediatrics, 2018, 142(1):e20173703.DOI:10.1542/peds.2017-3703.
[20] Harper L, Blanc T, Peycelon M, et al.Circumcision and risk of febrile urinary tract infection in boys with posterior urethral valves:result of the CIRCUP randomized trial[J].Eur Urol, 2022, 81(1):64-72.DOI:10.1016/j.eururo.2021.08.024.
[21] Holzman SA, Chamberlin JD, Davis-Dao CA, et al.Retractable foreskin reduces urinary tract infections in infant boys with vesicoureteral reflux[J].J Pediatr Urol, 2021, 17(2):209.e1-209.e6.DOI:10.1016/j.jpurol.2021.01.007.
[22] Gücük A, Burgu B, G k?e I, et al.Do antibiotic prophylaxis and/or circumcision change periurethral uropathogen colonization and urinary tract infection rates in boys with VUR?[J].J Pediatr Urol, 2013, 9(6 Pt B):1131-1136.DOI:10.1016/j.jpurol.2013.04.014.
[23] Alsaywid BS, Saleh H, Deshpande A, et al.High grade primary vesicoureteral reflux in boys:long-term results of a prospective cohort study[J].J Urol, 2010, 184(4 Suppl):1598-1603.DOI:10.1016/j.juro.2010.04.021.
Memo
收稿日期:2022-07-28。
基金项目:上海市卫生和计划生育委员会项目（201840136）；转化医学国家重大科技基础设施（上海）开放课题（TMSK—2020—104）
通讯作者:黄轶晨,Email:drhuangyichen@163.com