Division of Pediatric Emergency Medicine, Montréal Children’s Hospital, McGill University Health Centre, Montréal, Québec, Canada.
CMAJ. 2012 Oct 16;184(15):E796-803. doi: 10.1503/cmaj.111372. Epub 2012 Jul 9.
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.
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.
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]).
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.
未割包皮的男孩比割包皮的男孩更容易患尿路感染。但这种风险是否与尿道外口的可见度有关尚不清楚。我们的目的是确定尿道外口可见度不同的未割包皮男孩中，风险是否存在等级差异。
我们在一家儿科急诊室进行了一项前瞻性的横断面研究。我们对 440 名割包皮和未割包皮的男孩进行了筛查。其中，393 名未接受如厕训练且主治医生要求进行导尿管尿液培养的男孩被纳入我们的分析。在插入导尿管时，一名护士使用 3 分制（完全可见、部分可见或不可见）来描述尿道外口的可见度（包茎）。我们的主要结局是尿路感染，主要暴露变量是包茎程度：完全可见与部分或不可见的尿道外口。
30.0%完全可见尿道外口的未割包皮男孩和 23.8%部分或不可见尿道外口的未割包皮男孩的尿液样本培养出了细菌（p=0.4）。未调整的比值比（OR）为 0.73（95%置信区间[CI]0.35-1.52），调整后的 OR 为 0.41（95% CI 0.17-0.95）。已割包皮的男孩中有 4.8%发生了尿路感染，明显低于完全可见尿道外口的未割包皮男孩的感染率（未调整的 OR 0.12[95% CI 0.04-0.39]，调整后的 OR 0.07[95% CI 0.02-0.26]）。
我们未发现未割包皮男孩的尿道外口可见度与尿路感染风险之间存在差异。与割包皮的男孩相比，我们发现无论尿道是否可见，未割包皮的男孩尿路感染的风险都更高。
