The effect of circumcision status on periurethral and glanular bacterial flora.
BACKGROUND
Circumcision is a historical operation which is still performed for different purposes. The aim of this study is to investigate the changes in periurethral and glanular sulcus flora due to circumcision to determine the role of circumcision on urinary tract infections (UTIs).


METHODS
Fifty patients who were circumcised for social-religious reasons between January 2000 and January 2001 were evaluated in this prospective study. Two swabs were taken from the periurethral and glanular sulcus regions both just before circumcision and 4 weeks after, and the bacteria cultured were recorded.


RESULTS
We isolated pathogenic bacteria in the periurethral region of 32 (64%) patients (enterococci in 14 cases; Escherichia coli in 12 cases) before circumcision, and this number decreased to 5 (10%) after circumcision. Similarly, pathogenic bacteria were cultured from the glanular sulcus swabs of 33 (68%) patients (enterococci in 14 cases; E. coli in 10 cases), as well as coagulase-negative staphylococci in another 15 patients before circumcision. Following circumcision, we detected pathogenic bacteria in the glanular cultures of only 4 cases, whereas 40 children had non-pathogenic skin flora. Only 1 of 5 children with history of UTIs (n = 1) and retractable phimosis (n = 4) had periurethral pathogenic bacteria (Proteus spp.) in the post-circumcision period. The differences between pre- and post-circumcision values of the pathogenic bacterial colonizations were statistically significant in both groups sampled (p < 0.05).


CONCLUSIONS
Non-circumcised patients have similar pathogenic bacterial colonizations in the periurethral and the inner preputial regions, although they have no phimosis. The origin of periurethral flora should be the deeper preputial regions. The flora greatly changed with skin commensals after circumcision. Circumcision might be beneficial from this point of view.
Günşar
Cüneyt
C
Department of Pediatric Surgery, Celal Bayar University Medical Faculty, Manisa, Turkey. cgunsar@superonline.com
Kurutepe
Semra
S
Alparslan
Oğuz
O
Yilmaz
Omer
O
Dağlar
Zafer
Z
Sencan
Aydin
A
Genç
Abdülkadir
A
Taneli
Can
C
Mir
Erol
E
D001419:Bacteria / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male; D006801:Humans; D007223:Infant; D008297:Male; D010413:Penis / Q000382:microbiology*; D011446:Prospective Studies; D014521:Urethra / Q000382:microbiology*