All issues > Volume 35(8); 1992

Original Article

J Korean Pediatr Soc. 1992;35(8):1035-1043. Published online August 15, 1992.

Urinary Tract Infection and Neonatal Circumcision

Seung Joo SJ Lee¹

¹Department of Pediatrics, College of Medicine, Ewah Womans University, Seoul, Korea

Abstract

An association between urinary tract infection in male infants and uncircumcised status has been suggested recently. Male predominance of UTI in most reports in Korea may be related to this uncircumcised status. The present study was prospectively performed between Mar. 1989 and May. 1991 to investigate this relationship and the effect of neonatal circumcision on the intraurethral bacterial flora. 1) The frequency of UTI was 2.43% in total inpatient children, 2.41% in males and 2.44% in females. In circumcised males the rate was 1.03% which was significantly lower than 2.59% in uncircumcised males(p<0.01). 2) The high frequency of UTI in early life of uncircumcised males declined progressively with increasing age. 3) Male predominance of UTI with high male to female ratio (3.09) in early life became female predominance by age 3 year. 4) The circumcision rate in children with UTI was 4.9% which was significantly lower than 11.6% of children without UTI (p<0.01). 5) The incidence of urinary tract anomaly in circumcised male was 100% which was significantly higher than 21.6% of uncircumcised male and 29.6% of female. 6) The incidence of intraurethral aerobic colony counts over 103/ml in uncircumcised males was significantly higher than circumcised males in early life and decreased progressively with increasing age. 7) The median number of intraurethral coloy counts in uncircumcised male was also significantly higher than circumcised male who had low colony counts from early life. The difference was not significant by age 2 year. 8) The predominant uropathogen in uncircumcised male was changed from E. coli to G(+) cocci around age 1 year. In female E. coli remain constantly predominant during early childhood. 9) The incidence of UTI was jumped from 0~1.2% of children with colony counts below 105/ml to 53.8% in children with colony counts over 105/ml. The presence of a prepuce is associated with a great quantity of intraurethral uropathogens. This may be important in the pathogenesis of UTI in uncircumcised male infants and may be associated with male predominance of UTI by age 2~3 years in Korea.

Keywords :UTI, Neonatal circumcision, Intraurethral colony counts