518 - “To Circ or Not to Circ” — That Is the Question for Patients With Posterior Urethral Valves

Publication Number: 1498.518

Hans Bae, BC Children's Hospital, Surrey, BC, Canada; Alyssa Wong, University of British Columbia, Richmond, BC, Canada; Falla Xin Jin, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Hyunwoong Harry Chae, University of British Columbia, Vancouver, BC, Canada; Qian Zhang, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Abdullah Alshalan, University of British Columbia, Vancouver, BC, Canada; Douglas Matsell, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Jeffrey Bone, BCCHR, Vancouver, BC, Canada; Kourosh Afshar, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Erik Skarsgard, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Andrew MacNeily, Children's Hospital, vancouver, BC, Canada; Soojin Kim, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada

Background: Antibiotic prophylaxis (AP) and circumcision are commonly used to prevent urinary tract infections (UTIs) in children with posterior urethral valves (PUV), but there is insufficient research examining their efficacy when used together.

Objective: To compare the effectiveness of AP when used alone and in combination with circumcision in preventing UTIs in PUV patients.

Design/Methods: We retrospectively reviewed PUV patients managed at our institution from 2000-2019 with a 2-year follow-up period after initial presentation. Patients were classified as ‘AP-only’ if they received AP but not circumcision, or if circumcision occurred after AP initiation due to breakthrough UTIs. Patients were classified as ‘combined treatment’ if they received both AP and circumcision without intervening UTIs. UTIs were defined based on patient symptoms, microbiological confirmation, and/or clinical documentation. An inverse probability-weighted multivariable Poisson regression model was used to compare UTI incidence rates between treatment groups, while accounting for informative censoring due to treatment change and adjusting for neonatal intensive care unit (NICU) admission status, distance to hospital, and socioeconomic deprivation.

Results: Out of 61 patients with PUV, 41 received AP only (67.2%), 12 received combined treatment (19.7%), 4 received circumcision only (6.6%), and 4 received none of the two interventions (6.6%). Median age at circumcision, AP initiation, and first UTI was 120 days (interquartile range (IQR) 32, 355), 11 days (IQR 2, 40), and 52 days (IQR 18, 132), respectively. The incidence rate of UTIs in the AP-only group was 0.17 per person-year (95% CI 0.14, 0.22), and 0.05 per-person year in the combined treatment group (95% CI 0.02, 0.11). Multivariable analysis showed that patients who received combined treatment had a 74% lower UTI incidence rate compared to those who received only AP (incidence rate ratio 0.26; 95% CI 0.10, 0.65; p = 0.004). Greater patient distance from hospital (p = 0.02) and greater socioeconomic deprivation (p = 0.005) were each associated with higher UTI rates, whereas NICU admission was not significant (p = 0.83).

Conclusion(s): Combined treatment of circumcision with AP may be more effective than AP alone in preventing UTIs in PUV patients. In our cohort, geographical proximity to hospital and degree of socioeconomic deprivation were predictive of UTI occurrence. Further investigation through implementation of a national, multicenter PUV registry could inform future practices in the management of UTIs in PUV patients.