טיפים והדרכה לברית המילה

לפני הברית

א. רצוי להתקשר למוהל מיד לאחר הלידה
ב. תינוק כשיר לברית, בד"כ, החל ממשקל 2.500 ק"ג וערך הבילירובין עד 13 מ"ג
ג. בכל מקרה של ספק מומלץ שהילד יבדק על ידי רופא הילדים
ד. אם מסיבות בריאותיות הילד לא נימול ביום השמיני, יש לקיים הברית מיד לאחר אישור הרופא המטפל. שככל שהגיל צעיר יותר – יסבול פחות
ה. יש לבחור במוהל בעל כישורים לתת את התמיכה הרגשית גם להורי התינוק ברגעים חשובים אלו. 

מה להכין לברית

4 חיתולי בד
3 טיטולים
כרית בגודל בינוני
2 טליתות – לסנדק ולאבא
עגלה לתינוק

סירופ אקמולי
אבקת דרמטול
מגבונים לחים
משחת VITA-MARFEN או משחת בפנטן פלוס

גביע או כוס בקבוק מיץ ענבים או יין מתוק – סגור!

להאכיל את התינוק כשעה וחצי לפני הברית ולהוציא לו אוויר (גרפס) כדי שלא יבכה בברית

מה קורה לאחר הברית ?

מייד לאחר הברית אני מוסר הוראות טיפול בכתב כך שההורים יוכלו לקוראם אח"כ בנחת וברגיעה לאחר שובם הביתה.
למחרת הברית אני בודק שוב את התינוק ונותן להורים את הוראות הטיפול לקראת ההמשך.

מיד לאחר הברית אפשר להאכילו.
בבית יש לחתלו החתלה רגילה כאילו כלום לא קרה.
מאחר ולא הוזרקה זריקה – אין נפיחות, אין תופעות לוואי, ואין כאבים של חדירת מהמזרק.

אני עומד לרשותכם ולשרותכם במשך 24 שעות ביממה לכל שאלה או הבהרה בעניין בנכם היקר.

אז מה עשינו בברית..

להלן איור המסביר את מעשה המילה באופן כללי:
עור הפריעה, הנמצא מתחת לעטרה, עובר שינוי מלהיות עור פנימי לעור חיצוני. בשל היותו עור פנימי – צבעו אדום – זה נורמאלי לגמרי .
תופעה נוספת של השינוי שהוא עובר היא נפיחות. ב25% של הילדים עור הפריעה מתנפח. הוא מתמלא במים ונראה נפוח.
זה טבעי ובסדר גמור. הנפיחות יורדת לאחר כמה ימים עד שבוע.

brit22

הנחיות והמלצות להורים לאחר ברית המילה

"מזל טוב" על שזכיתם להביא את בנכם בברית המילה.
מבחינה רפואית מדובר בפעולה בטוחה ועם אחוז מזערי של בעיות וסיבוכים
כדי לסייע לכם בנושאים ובשאלות העולות במהלך הימים הראשונים שלאחר ברית המילה,
מוגש בזאת מדריך מיוחד ובו הנחיות לאחר ברית המילה.

יממה ראשונה לאחר הברית

טיפול בברית המילה:


א. כתמים ורודים אדמדמים על התחבושת ועל הטיטול בכמות ובמידה קטנה, זוהי תופעה שכיחה שאינה צריכה לעורר דאגה ולא דורשת טיפול מיוחד.
ב. בכל החלפת טיטול יש למרוח מסביב לתחבושת שעל ברית המילה בייבי פסטה (משחת החתלה) כדי לאטום אותה ששתן לא יכנס ויגע בפצע וישרוף.
ג. אם התחבושת של הברית נפלה יש להתקשר למוהל. אם יש דימום, עד שהמוהל יגיע, יש לכרוך רצועה דקה מהמגבון מסביב לאיבר הברית וללחוץ בעדינות עד שיעצר הדימום.
ד. כדי לוודא כי לא מדובר בדימום בעל משמעות, יש להחליף את הטיטול לעיתים תכופות לעקוב , ולהודיע מייד למוהל.

לאחרונה  נכנסו חומרים חדשים ומצויינים  מחדרי הניתוח לעבודה בבריתות .  בברית עצמה אני מניח רשת הנקראת "סורגיסל"  על האיבר  .  רשת זו דואגת לעצירת הדימום באופן מופלא . הרשת נהפכת לצבע כהה מאד עד שחור  .   על גבי רשת זו אני מניח תחבושת נוספת  שמגולגלת על ה"סורגיסל"  כאשר בסופה אני עושה גלגול  קטן  שיהוה נקודת אחיזה לשם הורדתה בקלות על ידי ההורים למחרת . 

אחרי הורדת החבישה החיצונית  מה שיתגלה  זה הרשת הפנימית הכהה שחורה .  אין להוריד רשת זו  .  היא לאט לאט נמסה ויורדת מעצמה.  

בנוסף  –  רשת זו יחד עם חומר נוסף שאני מניח על החבישה  גורם לגוף להפריש חומר צהבהב  על כל המקום . חומר זה נקרא פיברין  והוא מעולה כיון שהוא חלק ממנגנון הקרישה הטבעי –  הוא סוגר את כל כלי הדם ומאיץ את בניית רקמת החיבור לאיחוי  החתך .  אין לנסות לגרד ולהוריד שכבה זו  .  היא תתחיל להתפרק ולרדת לבד לאחר כמה ימים עד שבוע. 

כדי להרגיע את התינוק:
א. רצוי להאכיל את התינוק ללא הקפדה על זמני הארוחות הקבועים.
ב. אם סעיף א' לא עזר, לשקול תוך התייעצות רפואית על המינון בתדירות של נתינת סירופ אקמול לילדים.
ג. אם למרות הנ"ל התינוק ממשיך לבכות או שאינו רגוע באופן מיוחד יש לפנות למוהל .

חשש לחום:
א. ככלל, אין צורך לבדוק את חום התינוק.
ב. עליית חום עד 38 מעלות יכול להיות מחימום יתר בו נמצא התינוק, רצוי למנוע זאת ולהרבות בשתייה.
ג. אם למרות תוספת השתייה יש עליית חום מעל 38 מעלות יש ליידע את המוהל.

נתינת שתן:
א. יש לבדוק את רטיבות הטיטול לאחר 8 שעות.
ב. אם תוך 5 שעות לאחר הברית התינוק לא נתן שתן יש לפנות למוהל בהקדם.

צבע האיבר:
א. צבע העטרה חייב להיות אדום עד אדום כהה או קרוב לכך, כמו שהיה לפני הברית. 
ב. אם יש שינוי או ספק, יש להודיע למוהל.

לינק להוראות קופח כללית  לטפול לאחר הברית 

יממה שניה

הסרת התחבושת על ידי המוהל – אני מגיע בתיאום טלפוני.
אמבטיה – רק לאחר הסרת התחבושת על ידי המוהל.

בימים הראשונים לאחר הברית:
א. מופיע הפרשה במקום ברית המילה, זוהי תופעה רגילה לאחר הברית, מדובר בחומר בשם "פיברין".
המופרש משולי עור העורלה שמטרתו להתחיל את תהליך הגלדת הפצע וריפויו.
ב. רצוי לגלות ולחשוף את אזור הברית לאוויר לפרקי זמן קצרים במשך היום.
ג. אפשר למרוח על אזור הברית משחה כגון ויטה מרפן וכו'
ד. תפיחות בינונית של העטרה וסביבה הם תופעה שכיחה שחולפת מעצמה תוך ימים ספורים ואינה צריכה לעורר דאגה ולא דורשת טיפול מיוחד.

ה.  לפעמים  הצבע של העטרה נוטה לסגלגל .  בד"כ כתוצאה  מקור  .  יש  לעשות אמבטיה פושרת  ואז הצבע חוזר להיות  אדמדם.

סיכום מצבים המחייבים להתקשר למוהל בהקדם

א. דימום
ב. נפילת התחבושת
ג. הופעת חום מעל 38 מעלות
ד. שינוי צבע העטרה
ה. אי מתן שתן כעבור 5 שעות
ו. כשהתינוק אינו רגוע לאורך זמן

בריתות בערב שבת וערב חג:

א. כל ההנחיות דלעיל ללא כל שינוי חלים גם על שבת וחג.
ב. יש לקבל הנחיות מהמוהל כיצד ליצור קשר עמו בשבת ובחג.

האם כדאי לתת זריקת הרדמה?


WhatsApp-Image-2017-04-16-at-09.54

מחקרים רפואיים בנושא ברית המילה

From Medscape Education Clinical Briefs

AAP Issues Recommendations on Male Newborn Circumcision CME/CE

News Author: Yael Waknine

  CME Author: Charles P. Vega, MD, FAAFP Faculty and Disclosures

 

CME/CE Released: 09/05/2012; Valid for credit through 09/05/2013

 

CME/CE Information

Earn CME/CE Credit »

Clinical Context

 

Circumcision is one of the oldest procedures in medicine, and data from 

the US Centers for Disease Control and Prevention (CDC) suggest that more  

than half of male newborn infants in the United States receive  

circumcision in the hospital. The most common reason that parents cite for  

choosing circumcision is health and medical benefits, followed by social  

concerns. Religious concerns are less important in the overall practice of  

circumcision in the United States.

 

The current policy statement from the American Academy of Pediatrics (AAP) 

updates the group's previous recommendations from 1999. The principal  

recommendations along with their rationale are presented in the Study  

Highlights section.

Study Synopsis and Perspective

 

New scientific evidence shows that benefits of male circumcision (MC)  

outweigh its small risks and justify access to the procedure for families  

who choose it, according to an updated policy statement published online  

August 27 in Pediatrics by the AAP.

 

Benefits cited in the accompanying technical report compiled by the AAP  

Task Force include the prevention of urinary tract infections and  

decreased transmission of some sexually transmitted infections such as 

HIV/AIDS, herpes, and human papillomavirus (HPV), which has been linked to  

the development of cancer in men and their female partners.

 

The report also states that the procedure is "well tolerated when  

performed by trained professionals under sterile conditions with  

appropriate pain management," and that complications such as bleeding and  

infection are rare.

 

Although the procedure remains elective, prospective parents should be  

routinely educated regarding the procedure to make an informed decision.

 

"Ultimately, this is a decision that parents will have to make," said  

Susan Blank, MD, FAAP, in an AAP news release. "Parents are entitled to  

medically accurate and non-biased information about circumcision, and they  

should weigh this medical information in the context of their own  

religious, ethical and cultural beliefs."

 

"It's a good idea to have this conversation during pregnancy, and to learn  

whether your insurance will cover the procedure, so you have time to make  

the decision," Dr. Blank added, noting that MC should be performed during  

the newborn period to maximize both safety and health benefits.

 

Dr. Blank is chair of the task force that authored the AAP policy  

statement and technical report.

 

The AAP also supports third-party coverage of MC, the cost of which would  

be offset by significant long-term health savings.

 

Cuts in Coverage Could Cost $1 Billion

 

As previously reportedby Medscape Medical News, cuts in state coverage  

during the last 20 years have had a major effect on MC rates, which have  

decreased from 79% to 54.7%.

 

Mathematical modeling suggests that continued decreases leading to the  

European MC rate (10%) could inflate healthcare costs by nearly $916  

million for every birth cohort because of potentially preventable cases of  

HIV/AIDS, sexually transmitted infections, and cancer.

 

The updated policy confirms the "potential benefits" cited in the 1999 and  

2005 AAP statements and has been endorsed by the American College of  

Obstetricians and Gynecologists.

 

"This information will be helpful for obstetricians who are often the  

medical providers who counsel parents about circumcision," Sabrina Craigo,  

MD, the college's liaison to the AAP task force on circumcision, said in  

the news release. "We support the idea that parents choosing circumcision  

should have access to the procedure."

 

The majority of male urinary tract infections occur during the first year  

of life and may involve the possibility of an invasive procedure and  

hospitalization.

 

Literature analysis suggests that MC significantly decreases the incidence  

rate of urinary tract infections to 0.1% or 0.2% during this period  

compared with 0.7% to 1.4% for uncircumcised infants.

 

Plausible explanations for the effect include the decreased presence of  

uropathogenic bacteria around the urethral meatus of circumcised infants  

and a decreased bacterial adherence to the keratinized surface of the  

circumcised foreskin.

 

A review of the literature revealed a consistently reported protective  

effect of 40% to 60% for MC in reducing the risk for HIV acquisition among  

heterosexual men in areas with high disease prevalence, such as Africa.

 

CDC modeling based on these data suggests that circumcising all currently 

uncircumcised heterosexual US males would yield a 15.7% reduction in  

lifetime HIV risk for all men, given that heterosexual men account for 27%  

of new infections and 61% occur in men who have sex with men, for whom MC  

has not shown a protective effect.

 

According to the authors, the uncircumcised foreskin contains a high 

density of HIV target cells, has an easily abraded inner surface that can  

serve as a port of entry for pathogens, and "traps" pathogens in an  

incubation-friendly environment.

 

Two randomized African trials have yielded good evidence that MC confers a  

32% to 35% decrease in risk for oncogenic and nononcogenic HPV in men; 1  

study showed a 28% decrease in risk for male-to-female transmission of  

high-risk HPV from HIV-negative men.

 

Although penile cancer is rare and incidence rates seem to be declining in 

countries with both low and high MC rates (Denmark and the United States,  

respectively), fair evidence from 2 case-control studies has shown that  

the absence of circumcision confers a risk for invasive squamous cell  

carcinoma (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.3 – 4.1),  

but not carcinoma in situ (OR, 1.1).

 

According to the authors, the effect is likely derived from a reduced risk  

for phimosis (which raises the risk for invasive penile cancer by a factor  

of 11.4) and decreased prevalence of oncogenic HPV in circumcised men.

 

Persistent infection with oncogenic types of HPV is the main prerequisite  

to developing cervical squamous cell carcinoma, a leading cause of death  

for women in developing countries. One study showed a significantly  

decreased incidence of HPV in circumcised men with multiple female  

partners (5.5% vs 19.6% for uncircumcised men; OR, 0.37; 95% CI, 0.16 –  

0.85), which correlated to a significant decrease in the women's risk for  

cervical cancer (OR, .42).

 

Genital ulcers are notable for their association with morbidity and  

mortality and because their presence increases the risk for HIV  

transmission.

 

Genital herpes is a sexually transmitted infection that has been diagnosed  

at some point in 18.9% of Americans aged 20 to 49 years. Good evidence  

 from 2 randomized controlled African studies shows that MC decreases the  

risk for herpes simplex type 2 viral infection by from 28% to 34%; fair  

evidence suggests that MC protects female partners from infection as well.

 

According to a report by the CDC, the total number of syphilis cases in  

the United States has increased 2.2% (from 44,830 to 45,834 cases) during  

2009 to 2010, with 67% of primary and secondary cases in 2010 being  

reported in men who have sex with men. The balance of evidence suggests  

that MC decreases syphilis risk. A meta-analysis reported a relative risk  

of 0.67 (95% CI, 0.54 – 0.83), but considerable heterogeneity was observed  

among the studies included.

 

Bacterial vaginosis is common among pregnant women, affecting more than 1  

million annually. Several studies also provide good evidence that MC is  

protective against bacterial vaginosis in female partners.

 

Pediatrics. Published online August 27, 2012. Policy statement full text,  

Technical report full text

Study Highlights

 

Parents should receive factual and unbiased information on circumcision  

before conception and early in pregnancy. Currently, most parents decide  

whether to circumcise during this time and before discussing the subject  

with a clinician. Parents should understand that circumcision is an  

elective procedure.

The health benefits of newborn MC outweigh the potential risks, and these 

benefits justify access to circumcision for families who choose it.

Specifically, circumcision is associated with a lower prevalence of HPV  

infection and reduced transmission of herpes simplex virus type 2. It is  

also associated with a lower risk for bacterial vaginosis among female  

partners.

Circumcision does not appear protective against gonorrhea or chlamydia.

14 studies provide fair evidence that circumcision is protective against  

heterosexually acquired HIV infection among men. In fact, it is a  

cost-effective means to reduce the prevalence of HIV infection.

Circumcision is less likely to be protective against HIV infection among 

men who have sex with men.

Circumcision is associated with a lower risk for urinary tract infection  

among children younger than 2 years.

Circumcision also reduces the risk for penile cancer, although the number  

of circumcisions required to prevent 1 additional case of this rare cancer  

is very high.

2 controlled trials of adult circumcision found improved sexual  

satisfaction and sensitivity after circumcision. Good evidence exists that  

sexual function is not impaired among circumcised vs uncircumcised men.

Provider experience and skill in circumcision outweigh the training  

background of the provider.

Analgesia should be provided during circumcision, and nonpharmacologic  

techniques such as positioning or sucrose pacifiers are insufficient as  

the only means to reduce procedural pain. Nerve blocks are more effective  

than topical lidocaine-prilocaine in reducing pain during and after  

circumcision.

Significant acute complications of newborn MC occur in approximately 1 in  

500 cases. The specific technique of circumcision used does little to  

influence the risk for adverse events.

In a study by the CDC, the average cost of circumcision ranged between  

$216 and $601. Circumcision rates are higher in states where Medicaid  

covers the procedure. The health benefits of circumcision warrant  

third-party reimbursement of the surgery.

Professional organizations should collaborate to promote better standards  

for training in circumcision and offering new training opportunities.

 

Clinical Implications

 

Circumcision is associated with a lower prevalence of HPV infection and  

reduced transmission of herpes simplex virus type 2. Circumcision does not  

appear protective against gonorrhea or chlamydia. Circumcision prevents  

HIV infection among heterosexual men but not among men who have sex with 

men.

The current recommendations from the AAP state that the health benefits of  

newborn MC outweigh the potential risks, and these benefits justify access 

to circumcision for families who choose it.

From Medscape Education Clinical Briefs

Urinary Tract Infections Higher in Uncircumcised vs Circumcised Boys CME

News Author: Troy Brown

  CME Author: Désirée Lie, MD, MSEd Faculty and Disclosures

 

CME Released: 07/12/2012; Valid for credit through 07/12/2013

 

CME Information

Earn CME Credit »

Clinical Context

 

According to the current study by Dubrovsky and colleagues, uncircumcised  

boys are at higher risk for urinary tract infections than circumcised  

boys, most likely as a result of heavier colonization under the foreskin  

with pathogenic bacteria, which leads to ascending infections. However,  

whether all uncircumcised boys are at equal risk for infection, or whether  

the risk varies with the visibility of the urethral opening, is not known.

 

This cross-sectional study compares the proportions of urinary tract  

infections among uncircumcised boys with a completely visible meatus vs  

those with a partially or nonvisible meatus and determines whether a  

hierarchy of risk exists among uncircumcised boys whose urethral meatuses  

are visible to differing degrees.

Study Synopsis and Perspective

 

All uncircumcised boys have a higher risk for acquiring a urinary tract  

infection, regardless of the degree of urethral meatus visibility  

(phimosis), according to a recent prospective cross-sectional study  

published online July 9 in the Canadian Medical Association Journal.

 

Alexander Sasha Dubrovsky, MDCM, a physician in the Division of Pediatric  

Emergency Medicine at Montreal Children's Hospital, McGill University  

Health Centre, Quebec, Canada, and colleagues explain that urinary tract  

infections are much more common in uncircumcised boys than in circumcised  

boys, and that some believe that the visibility of the urethral meatus  

(phimosis) plays a role, with the highest risk being in boys whose meatus  

is partially visible or nonvisible.

 

Dr. Dubrovsky and colleagues conducted a prospective cross-sectional study  

in a tertiary care pediatric emergency department of boys aged 3 years or  

younger who were not yet toilet trained and who had catheter-obtained  

urine culture ordered. Patients were screened for enrollment between April  

2007 and December 2009 and were excluded if they had received antibiotics  

within 72 hours before their emergency department visit, catheter  

insertion within the previous 7 days, or any genitourinary anomalies that  

prevented catheter insertion.

 

Study participants were placed into 1 of 3 groups: circumcised boys,  

uncircumcised boys with a partially or nonvisible urethral meatus, and  

uncircumcised boys with an entirely visible meatus.

 

Participant Characteristics

 

Of the 404 patients enrolled in the study, urine culture results were  

available for 393 boys. Of those children, 40 boys were uncircumcised with  

a completely visible meatus, 106 had a partially visible meatus, 163 had a  

nonvisible meatus, and 84 were circumcised. Phimosis was assessed by the  

nurse at the time of catheterization.

 

The median age of the participants was 3.9 months (interquartile range  

[IQR], 1.5 – 11.2 months); 44.0% (173/393) of the boys were younger than 3  

months. Uncircumcised boys with a completely visible meatus were older  

(11.6 months; IQR, 2.8 – 18.5 months) than the boys with a partially or  

nonvisible meatus (3.4 months; IQR, 1.4 – 8.9 months).

 

The meatus was completely visible in only 7.9% (11/140) of uncircumcised  

boys younger than 3 months compared with 32.3% (20/62) of boys aged 12  

months or older.

 

Caution Urged

 

A total of 80/393 boys (20.4%) had urinary tract infections. Of those with  

a completely visible meatus, 30.0% (12/40) had urinary tract infection  

compared with 23.8% (64/269) of boys with a partially or nonvisible meatus  

(P = .4).

 

The unadjusted odds ratio for urinary tract infection in boys with a  

partially or nonvisible meatus compared with those with a completely  

visible meatus was 0.73 (95% confidence interval [CI], 0.35 – 1.52).

 

The only variable the researchers retained in their multivariable logistic  

regression was age. The adjusted odds ratio was 0.41 (95% CI, 0.17 – 0.95;  

P = .04). This suggests the possibility that the risk for urinary tract  

infection is significantly lower among boys with a partially or nonvisible  

meatus compared with boys with a completely visible meatus, the authors  

write.

 

"Although we cannot exclude the possibility that [boys with a completely 

visible meatus are] truly at higher risk (contrary to our hypothesis),  

this result should be interpreted with caution given the small number of  

participants in the completely visible group," the authors write.  

"Furthermore, no previous studies suggest such an association, nor is  

there an apparent physiologic mechanism to explain this finding."

 

All Uncircumcised Boys at Higher Risk

 

"Our results suggest that uncircumcised boys presenting with clinical  

symptoms or signs suggesting urinary tract infection are at equal risk for  

urinary tract infection irrespective of the visibility of the urethra.  

Clinicians should continue to use circumcision status alone, not the  

degree of phimosis, to decide which boys should undergo investigation for  

urinary tract infection," the authors conclude.

 

This study was funded by the Montreal Children's Hospital Research  

Institute Clinical Projects Funding Competition for fellowship projects.  

All of the authors are members of the Research Institute of the McGill  

University Health Centre, which is supported by the Fonds de Recherche du  

Québec–Santé. The authors have disclosed no other relevant financial  

relationships.

 

CMAJ. Published online July 9, 2012. Full text

Study Highlights

 

The study was conducted at a tertiary care emergency pediatric department  

with a volume of 79,000 patients per year.

All boys 3 years or younger who were not toilet trained and for whom a  

catheter urine culture had been requested by their treating clinician were  

eligible for inclusion.

Exclusion criteria were use of antibiotic agents within the 72 hours  

preceding presentation to the emergency department, insertion of a  

catheter within the previous 7 days, or congenital genitourinary anomalies  

that precluded the insertion of a catheter.

3 groups of boys were assessed: (1) circumcised boys; (2) uncircumcised  

boys with a partially or nonvisible urethral meatus; and (3) uncircumcised  

boys with a completely visible meatus.

Urine samples were obtained for culture from boys presenting to the  

emergency department with signs or symptoms suggesting urinary tract  

infection.

Urine samples from boys 3 months or older were taken for bag urinalysis,  

whereas boys younger than 3 months had catheter samples taken.

A positive urinalysis result, defined as the presence of leukocyte  

esterase, nitrite, and/or 10 or more white blood cells per high-power  

field triggered obtaining a sample via catheter for boys 3 months or older.

Catheters were inserted by use of a standard sterile technique by nurses  

in the emergency department, who then completed a brief questionnaire.

The primary outcome measure was urinary tract infection, defined as growth  

of a single organism on culture (≥ 107 colony-forming units/L).

The primary exposure variable was the degree of phimosis (ie, the degree  

of visibility of the urethral meatus — completely visible vs partially or  

nonvisible).

A 3-point scale was used to classify the degree of visibility of the  

urethral opening that best reflected what was seen during catheter  

insertion.

At the time of insertion, the nurse assessed the degree of visibility by  

gently retracting the foreskin (avoiding any discomfort to the child) and  

comparing the observed anatomy with 3 drawings.

A second nurse conducted an independent assessment on a convenience sample  

of the uncircumcised boys (63/309) just before their catheters were  

inserted as a measure of interobserver reliability.

Confounders controlled for included risk factors for urinary tract  

infections in children: fever (temperature > 38°C), previous urinary tract  

infections, history of breast-feeding, presence of bronchiolitis, and age  

(< 3 months, ≥ 3 to < 12 months, and ≥ 12 months).

Urine culture results were available for 393 (97.3%) of 404 eligible  

patients.

Of the 393 boys included in the analysis, 40 were uncircumcised with a 

completely visible meatus, 269 had a partially (n = 106) or nonvisible (n  

= 163) meatus, and 84 were circumcised.

Median age was 3.9 months, and 44.0% were younger than 3 months.

Uncircumcised boys with a completely visible meatus were older (11.6  

months) than those with a partially or nonvisible meatus (3.4 months).

Triage category, length of stay, time of presentation, visits that  

occurred on a weekend, triage complaints, and diagnoses at discharge were  

similar among the 3 groups.

The rate of hospital admission for boys with a partially or nonvisible  

meatus was 29.7% vs 15.0% for boys with a completely visible meatus.

However, the rate of hospital admission after a positive urine culture  

result showed no significant difference among these groups.

Only 1.2% of circumcised boys were admitted after a positive urine culture  

result vs 8.4% of uncircumcised boys.

Of the 393 boys included in the study, 80 (20.4%) had urinary tract  

infections.

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, not significantly different).

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 (adjusted odds ratio, 0.07; 95% CI,  

0.02 – 0.26).

The authors concluded that although urinary tract infections in boys were  

more frequent in uncircumcised vs circumcised boys, the visibility of the  

meatus did not affect the risk for urinary tract infections.

 

Clinical Implications

 

In uncircumcised boys 3 years and younger, the odds of having a urinary  

tract infection is not affected by the visibility of the meatus.

The risk for urinary tract infection is higher in uncircumcised vs  

circumcised boys younger than 3 years.