Visibility of the urethral meatus and risk of urinary tract infections in uncircumcised boys.
BACKGROUND
Uncircumcised boys are at higher risk for urinary tract infections than circumcised boys. Whether this risk varies with the visibility of the urethral meatus is not known. Our aim was to determine whether there is a hierarchy of risk among uncircumcised boys whose urethral meatuses are visible to differing degrees.


METHODS
We conducted a prospective cross-sectional study in one pediatric emergency department. We screened 440 circumcised and uncircumcised boys. Of these, 393 boys who were not toilet trained and for whom the treating physician had requested a catheter urine culture were included in our analysis. At the time of catheter insertion, a nurse characterized the visibility of the urethral meatus (phimosis) using a 3-point scale (completely visible, partially visible or nonvisible). Our primary outcome was urinary tract infection, and our primary exposure variable was the degree of phimosis: completely visible versus partially or nonvisible urethral meatus.


RESULTS
Cultures grew from urine samples from 30.0% of uncircumcised boys with a completely visible meatus, and from 23.8% of those with a partially or nonvisible meatus (p = 0.4). The unadjusted odds ratio (OR) for culture growth was 0.73 (95% confidence interval [CI] 0.35-1.52), and the adjusted OR was 0.41 (95% CI 0.17-0.95). Of the boys who were circumcised, 4.8% had urinary tract infections, which was significantly lower than the rate among uncircumcised boys with a completely visible urethral meatus (unadjusted OR 0.12 [95% CI 0.04-0.39], adjusted OR 0.07 [95% CI 0.02-0.26]).


CONCLUSIONS
We did not see variation in the risk of urinary tract infection with the visibility of the urethral meatus among uncircumcised boys. Compared with circumcised boys, we saw a higher risk of urinary tract infection in uncircumcised boys, irrespective of urethral visibility.
Division of Pediatric Emergency Medicine, Montréal Children’s Hospital, McGill University Health Centre, Montréal, Québec, Canada. sasha.dubrovsky@mcgill.ca
Alexander Sasha
AS
Dubrovsky
Bethany J
BJ
Foster
Roman
R
Jednak
Elise
E
Mok
David
D
McGillivray
D002675:Child, Preschool; D002944:Circumcision, Male; D003430:Cross-Sectional Studies; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D014521:Urethra / Q000033:anatomy & histology*; D014546:Urinary Catheterization; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000209:etiology*; D014556:Urine / Q000382:microbiology