Introduction: Circumcision has been suspected to reduce the risk of urinary tract infection (UTI) in boys with congenital urinary tract anomalies, including hydronephrosis. Our aim was to compare the rates of UTI in circumcised vs. uncircumcised boys with reported antenatal hydronephrosis by conducting a systematic review and meta-analysis.

Methods: A search was performed in December 2021. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed measures included rates of UTIs, antibiotic prophylaxis use, and a number of renal outcomes, including renal function and cortical scarring, as well as circumcision complications. Odds ratios (OR) and mean difference with 95% confidence interval (CI) were extrapolated from available data. Random-effects meta-analysis was performed and confounders were assessed with subgroup analysis.

Results: Fourteen studies describing 7424 boys with antenatal hydronephrosis were included. Overall effect estimates demonstrate that circumcised boys have a significantly reduced odds of developing any UTI (OR 0.22, 95% CI 0.16, 0.32, p<0.001) compared to uncircumcised patients. This translates into five times higher risk of UTI if uncircumcised. There was no difference in continuous antibiotic prophylaxis use between groups (OR 1.16, 95% CI 0.91,1.49, p=0.22). The reported definitions of UTIs were varied. Long-term renal function, development of scars, and postoperative complications were not consistently reported, which prohibited pooling. The majority of studies had moderate risk of bias.

Conclusions: Current evidence suggests that circumcision reduces the frequency of UTIs in boys with antenatal hydronephrosis. Further research with adequate reporting of causes for hydronephrosis and randomized studies are required to determine clinical significance.