Skip to main content

Urethra Visibility Does Not Change UTI Risk


July 9, 2012 — All uncircumcised boys have a higher risk for acquiring a urinary tract infection, regardless of the degree of urethral meatus visibility (phimosis), according to a recent prospective cross-sectional study published online July 9 in theCanadian Medical Association Journal.
Alexander Sasha Dubrovsky, MDCM, a physician in the Division of Pediatric Emergency Medicine at Montreal Children's Hospital, McGill University Health Centre, Quebec, Canada, and colleagues explain that urinary tract infections are much more common in uncircumcised boys than in circumcised boys, and that some believe that the visibility of the urethral meatus (phimosis) plays a role, with the highest risk being in boys whose meatus is partially visible or nonvisible.
Dr. Dubrovsky and colleagues conducted a prospective cross-sectional study in a tertiary care pediatric emergency department of boys aged 3 years or younger who were not yet toilet trained and who had catheter-obtained urine culture ordered. Patients were screened for enrollment between April 2007 and December 2009 and were excluded if they had received antibiotics within 72 hours before their emergency department visit, catheter insertion within the previous 7 days, or any genitourinary anomalies that prevented catheter insertion.
Study participants were placed into 1 of 3 groups: circumcised boys, uncircumcised boys with a partially or nonvisible urethral meatus, and uncircumcised boys with an entirely visible meatus.
Participant Characteristics
Of the 404 patients enrolled in the study, urine culture results were available for 393 boys. Of those children, 40 boys were uncircumcised with a completely visible meatus, 106 had a partially visible meatus, 163 had a nonvisible meatus, and 84 were circumcised. Phimosis was assessed by the nurse at the time of catheterization.
The median age of the participants was 3.9 months (interquartile range [IQR], 1.5 - 11.2 months); 44.0% (173/393) of the boys were younger than 3 months. Uncircumcised boys with a completely visible meatus were older (11.6 months; IQR, 2.8 - 18.5 months) than the boys with a partially or nonvisible meatus (3.4 months; IQR, 1.4 - 8.9 months).
The meatus was completely visible in only 7.9% (11/140) of uncircumcised boys younger than 3 months compared with 32.3% (20/62) of boys aged 12 months or older.
Caution Urged
A total of 80/393 boys (20.4%) had urinary tract infections. Of those with a completely visible meatus, 30.0% (12/40) had urinary tract infection compared with 23.8% (64/269) of boys with a partially or nonvisible meatus (P = .4).
The unadjusted odds ratio for urinary tract infection in boys with a partially or nonvisible meatus compared with those with a completely visible meatus was 0.73 (95% confidence interval [CI], 0.35 - 1.52).
The only variable the researchers retained in their multivariable logistic regression was age. The adjusted odds ratio was 0.41 (95% CI, 0.17 - 0.95; P = .04). This suggests the possibility that the risk for urinary tract infection is significantly lower among boys with a partially or nonvisible meatus compared with boys with a completely visible meatus, the authors write.
"Although we cannot exclude the possibility that [boys with a completely visible meatus are] truly at higher risk (contrary to our hypothesis), this result should be interpreted with caution given the small number of participants in the completely visible group," the authors write. "Furthermore, no previous studies suggest such an association, nor is there an apparent physiologic mechanism to explain this finding."
All Uncircumcised Boys at Higher Risk
"Our results suggest that uncircumcised boys presenting with clinical symptoms or signs suggesting urinary tract infection are at equal risk for urinary tract infection irrespective of the visibility of the urethra. Clinicians should continue to use circumcision status alone, not the degree of phimosis, to decide which boys should undergo investigation for urinary tract infection," the authors conclude.
This study was funded by the Montreal Children's Hospital Research Institute Clinical Projects Funding Competition for fellowship projects. All of the authors are members of the Research Institute of the McGill University Health Centre, which is supported by the Fonds de Recherche du Québec–Santé. The authors have disclosed no other relevant financial relationships.

Comments

  1. Anonymous15 October 2013 at 19:50

    I love it when individuals get together and share opinions.

    Great site, keep it up!

    Look into my weblog ... cheapest web traffic

    ReplyDelete

Post a Comment

Popular posts from this blog

Antidepressants Linked to Higher Diabetes Risk in Kids

Pediatric patients who use antidepressants may have an elevated risk for type 2 diabetes, the authors of a new study report. In a retrospective cohort study of more than 119,000 youths 5 to 20 years of age, the risk for incident type 2 diabetes was nearly twice as high among current users of certain types of antidepressants as among former users, Mehmet Burcu, PhD, and colleagues report in an article  published online October 16 in  JAMA Pediatrics . The risk intensified with increasing duration of use, greater cumulative doses, and higher daily doses of these antidepressants. The findings point to a growing need for closer monitoring of these products, including greater balancing of risks and benefits, in the pediatric population, the authors caution. They undertook the study because, despite growing evidence of an association between antidepressant use and an increased risk for type 2 diabetes in adults, similar research in pediatric patients was scarce. "To our know...
Post a Comment
Read more

Contact Precautions May Have Unintended Consequences

Contact precautions, including gloves, gowns, and isolated rooms, have helped stem the transmission of hospital pathogens but have also had some negative consequences, according to findings from a new study. Healthcare worker (HCWs) visited patients on contact precautions less frequently than other patients and spent less time with those patients when they did visit, report Daniel J. Morgan, MD, from the University of Maryland School of Medicine and the Veterans Affairs (VA) Maryland Health Care System, Baltimore, and colleagues. Moreover, patients on contact precautions also received fewer outside visitors. "Less contact with HCWs suggests that other unintended consequences of contact precautions still exist," Dr. Morgan and coauthors write. "The resulting decrease in HCW contact may lead to increased adverse events and a lower quality of patient care due to less consistent patient monitoring and poorer adherence to standard adverse event prevention methods (such...
Post a Comment
Read more

FDA Decision Delayed for Truvada in HIV PrEP

June 11, 2012 — The US Food and Drug Administration (FDA) has delayed its decision on allowing the use of tenofovir disoproxil fumarate/emtricitabine ( Truvada , Gilead) as preexposure prophylaxis (PrEP) so that the proposed risk evaluation and mitigation strategy (REMS) can be reviewed. In early May, the FDA's Antiviral Drugs Advisory Committee  strongly backed  approval of the first-ever drug for the prevention of sexually acquired HIV-1 infection. However, concerns by the panel at the time included that people may neglect condom use if they feel they are protected by PrEP. Panelists were also concerned that uninfected people taking PrEP who become infected with HIV may not switch to a 3-drug regimen as recommended. According to the company, the FDA has postponed the target date to September 14 so it can review Gilead's REMS plan to help ensure that patients will not misuse the drug. The committee's recommendation for supplemental approval of tenofovir/emtricit...
Post a Comment
Read more