Circumcision reduces urinary tract infection in children with antenatal hydronephrosis: Systematic review and meta-analysis

Introduction Urinary tract infection (UTI) is more prevalent in boys with antenatal hydronephrosis (ANH). Circum-cision is known to lessen the risk of UTI. This study was performed to examine the associations between circumcision and UTI among patients with ANH.Methods The Preferred Reporting Items for Systematic Re-views and Meta-Analyses standards were followed for conducting this systematic review and meta -analysis. PubMed, ScienceDirect, EMBASE, and Cochrane Library databases were searched through August 4th, 2022 to identify eligible studies. The risk of bias was measured using the Newcastle-Ottawa Scale (NOS). Review manager 5.4 was used for all analysis.Results A total of 21 studies involving 8,968 patients with ANH were included in the meta-analysis. The in-cidences of UTI were 18.1% in the uncircumcised group and 4.9% in the circumcised group. From analysis, circumcision had significant protective ef-fect against UTI with pooled OR of 0.28 (95% CI 0.23-0.32). The significant protective effects were also found in subgroup analysis of hydronephrosis etiology, including vesicoureteral reflux (pooled OR of 0.24; 95% CI 0.17-0.32), obstructive hydro-nephrosis (pooled OR of 0.34; 95% CI 0.21-0.53), and posterior urethral valve (pooled OR of 0.28; 95% CI 0.16-0.52).Conclusion Our meta-analysis showed that circumcision was associated with a decreased incidence of UTI in children with ANH. This benefit was consistent irre-spective of the underlying cause of hydronephrosis.