ROLE OF CIRCUMCISION IN UTI
AZHAN BIN YUSOFF
JUNE 2013
CONTENT
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DEFINATION
HISTORY
INCIDENCE
EVIDENCE
PHIMOSIS
PARENT COUNSEL
CONCLUSION
DEFINATION - UTI
DEFINATION- CIRCUMCISION
• Come from word latin circumcisio meaning to
cut around
• CIRCUMCISION – surgical removal of the
foreskin ( prepuce ) from human penis
• Ritual circumcision – non therapeutic
circumcision
HISTORY
Circumcision has been recorded more
than 4000 years, as evidenced by
Egyptian mummies and wall carvings
(Alanis, 2004).
HISTORY
Most common minor surgical
procedure approximately 25
circumcisions performed every
minutes worldwide (Hammond,
1999).
CIRCUMCISION
Indication
• Medical cause : phimosis,
phimosis with recurrent
balanoposthitis & recurrent
UTI in pt with urinary tract
abnormality ( VUR )
• Religious , cultural ,social
Contraindication
• Coagulopathy
• Acute local infection
• Congenital anomalies of
penis eg. Hypospadias or
buried penis
– Foreskin required for a
reconstructive procedure
METHOD
Forcep guided method( Guilotine)
Dorsal slit method
METHOD
Sleeve resection method
Clamp - eg Plastibell clamp
METHOD
Smart Clamp
Sunathrone Clamp
COMPLICATIONS
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Rate is low 2- 10%
Mostly mild/minor
Most common - bleeding
Others - Hematoma
Infection
Transected gland
Meatal stenosis
Urethral injury
CURRENT WORLD PREVALANCE FOR
MALE CIRCUMCISION
INCIDENCE OF UTI
• Varies with age and sex
• Overall incidence in prepubertal population
3% - girls
1% - boys
• Female - incidence increased with age
(infant girls 0.1-0.4%,school age girl 0.7- 2.3%)
• Male - incidence decreased with age
(infant boy 0.2-0.7%,school age boy 0.04-0.2%
IS THERE ANY ROLE
OF CIRCUMCISION IN
MANAGEMENT OF
UTI ?
EVIDENCES
STATISTICS
OTHER EVIDENCE
• Infant circumcision prevents 20 000 cases of acute
pyelonephritis annually
- Roberts JA : Neonatal circumcision : an end to the
controversy? South Med J 1996; 89:167
• In premature uncircumcised boys whose risk of UTI
was increased 11 fold , by circumcision the risk of
recurrence was eliminated
- Cason et al : Can circumcision prevent recurrent
urinary tract infections in hospitalized infants? Clin
Pediatr (Phila) 2000;39:699
• The Pediatric Research in Office Settings
Febrile Infant Study of 219 United States
practices found that being uncircumcised was
the strongest multivariate predictor of UTI
- Newman et al . Arch Pediatr Adolesc Med
2002;156:44
PHIMOSIS
• Def : tightening of penile foreskin
• Type : 1. Primary / Physiological
2. Secondary/ Pathological ( eg BXO )
• Diagnosis : clinical examination
PHIMOSIS
• Treatment options :
1. Surgical - Circumcision
- Plastic surgery–widen the foreskin
(eg Dorsal slit )
2. Medical - Corticoid ointment/cream
( bethamethasone 5% ) + manual stretching
HOW TO COUNSEL PARENTS FOR
CIRCUMCISION
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What is circumcision
History
Method
Indication and Contraindication
Benefit Vs Risk
Post op pain and follow up
PARENTS WILL DECIDE
CONCLUSIONS
Significantly reduce relative risk of
UTI esp in high risk group
In modern world, fairly a safe
surgery
• Absolute indication for circumcision is
secondary phimosis
• Indication in primary phimosis are recurrent
balanoposthitis and recurrent UTI in pt with
urinary tract abnormalities
-( LE : 2 , GR : B )
• In VUR - Circumcision during early infancy may be
considered as part of conservative approach as it
significantly reduces the risk of infection
• Childhood circumcision has an appreciable
morbidity and should not be recommended
without a medical indication
- ( LE : 2 , GR : B )
THANK YOU