İbrahim GÖKÇE, Neşe BIYIKLI, Nihal ÖZDEMİR, Ahmet TOPUZOĞLU, Harika ALPAY

Çocuklarda sünnetin idrar yolu enfeksiyonu sıklığı üzerine etkisi

Amaç: Çocuklarda yenidoğan dönemi sonrası yapılan sünnetin idrar yolu enfeksiyonu sıklığı üzerine etkisini değerlendirmektir.Gereç ve Yöntem: İdrar yolu enfeksiyonu geçiren yaşları 1-70 ay (ortanca 5 ay) arasında 56 erkek çocuk çalışmaya alındı. Tüm hastalara böbrek ultrasonografisi ve dimerkaptosüksinik asit sintigrafisi başvuruda uygulandı. “İşeme sistoüretrografisi” seçilmiş hastalara yapıldı. Otuz-üç hastada vezikoüreteral reflü tespit edilmedi, 23 hastada 1-3 dereceli vezikoüreteral reflü vardı. Hastalardan düzenli aralıklarla idrar kültürleri alındı, idrar yolu enfeksiyonu idrar kültüründe >105 cfu/ml tek bir organizmanın üremesi olarak tanımlandı. İdrar örneği başına (sayı) ve takip süresi (ay) boyunca geçirilen idrar yolu enfeksiyonu sıklığı sünnet öncesi ve sonrası değerlendirilerek karşılaştırıldı.Bulgular: İdrar yolu enfeksiyonu sıklığı, kültür başına sünnet öncesi ortanca 0,33 (IR; 0,21) ve sünnet sonrası 0,0 (IR; 0,50) bulundu. Takip süresi boyunca geçirilen idrar yolu enfeksiyonu sıklığı, sünnet öncesi ortanca 0,37 (IR; 0,51) ve sünnet sonrası 0,0’dı (IR; 0,0). Vezikoüreteral reflüsü olmayanlar ve düşük dereceli reflüsü olanlar için ayrı ayrı analiz yapıldığında benzer şekilde sünnet sonrası idrar yolu enfeksiyonu sıklığının her iki grupta azaldığı görüldü. Çıkarımlar: Bu çalışmada yenidoğan dönemi sonrası yapılan sünnetin, vezikoüreteral reflüsü olan ve olmayan hastalarda idrar yolu enfeksiyonu sıklığını azalttığı gösterilmiştir.

Effect of circumcision on urinary tract infection in boys

Aim: To assess the effect of circumcision after the newborn period on recurrence of urinary tract infections (UTI) in boys. Material and Method: Fifty-six boys ranging in age from 1 to 70 months (median 5 months) with UTI were evaluated retrospectively. Renal ultrasonography and dimercaptosuccinic acid scan were performed in all patients at admission. Voiding-cystourethrography was performed in selected patients. Thirty-three boys had no underlying vesicoureteral reflux (VUR), 23 boys had VUR grade 1-3. Regular urine samples were cultured to detect UTI, defined as a single species with >105 colony-forming units/ml. Number of UTI per urine sample (number) and per follow-up time (month) were compared before and after circumcision. Results: In the whole group; median UTI per sample was 0.33 (IR; 0.21) before circumcision and 0.0 (IR; 0.50) after circumcision, median UTI per month was 0.37 (IR; 0.51) before circumcision and 0.0 (IR; 0.0) after circumcision. When the analysis was done seperately, UTI episodes were significantly lower after circumcision both in patients with no underlying urinary tract anomaly and patients with low grade reflux.Conclusions: This study suggests that circumcision after the newborn period decreases recurrence of urinary tract infections in preschool boys with and without reflux.

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