Circumcision and continuous antibiotic prophylaxis in preventing recurrent febrile urinary tract infection in boys with high-grade vesicoureteral reflux

Abstract

OBJECTIVE: To evaluate the effectiveness of circumcision and continuous antibiotic prophylaxis (CAP) in preventing febrile urinary tract infection (fUTI) in boys with high-grade primary vesicoureteral reflux (VUR). METHODS: This retrospective cohort included 114 boys younger than 5 years diagnosed with grades III-V primary VUR between June 2019 and June 2022. Patients were managed with observation (n = 14), CAP alone (n = 23), circumcision alone (n = 38), and combined CAP and circumcision (n = 39). The follow-up duration was 2 years. The incidence of fUTIs in each group was recorded, and associations between conservative management strategies and fUTI recurrence were analyzed. RESULTS: 15 (13.2%) children experienced recurrent fUTIs. Recurrence rates were 42.9% in the observation group, 30.4% in the CAP group, 5.3% in the circumcision group, and 0% in the CAP+ circumcision group. Circumcision-containing groups (circumcision alone and CAP + circumcision) had significantly lower recurrence rates than non-circumcision groups (observation and CAP alone) (p < 0.05). Multivariable Firth-penalized logistic regression confirmed circumcision as an independent protective factor against fUTI recurrence (aOR = 0.09, 95% CI: 0.01-0.98, p = 0.042), while CAP alone showed no significant protective effect (aOR = 0.45, 95% CI: 0.06-3.21, p = 0.421). CONCLUSION: Circumcision significantly reduced fUTI recurrence in boys with grade III-V primary VUR and may represent an important component of conservative management in this high-risk population, whereas the added value of CAP remains uncertain.