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Urinary tract infection

416 bytes added, 28 March
UTIs in boys: Wikify.
|volume=69
|pages=409-412
}}</ref><ref name="McCracken 1989">{{REFjournal
|last=McCracken
|init=GH
|date=1989
|pages=598-599
}}</ref> which binds to the [[glans penis ]] of the infant.<ref name="Cunningham 1986">{{REFjournal
|last=Cunningham
|init=N
|issue=2
|page=267
}}</ref> Urinary tract infections (UTI) are a [[complication ]] of [[circumcision]].<ref>{{REFjournal
|last=Smith
|init=RM
== Treatment ==
The most common way of relieving a urinary tract infection is the administration of prescription antibiotics,<ref name="ginsburg uti"/> <ref name="McCracken 1989"/> if the infection does not clear up on its own. Drinking cranberry juice is a home remedy that may also help.
== Recurrent UTI ==
|first3=Carla M.
|init3=CM
|init4last4=Lohr
|first4=Jacob A.
|init4=JA
=== Breastfeeding ===
It was determined in the 1990s that [[breastfeeding ]] plays a central role substantially reducing the incidence of UTIs.<ref name="Winberg 1989"/><ref>{{REFjournal
|last=Pisacane
|init=A
Doctors and parents should refrain from touching a child's genitals as much as possible, as this could introduce E. coli into the urinary tract. When changing a child's diaper/nappy, parents should make sure their hands are sanitized, and be careful not to touch the area near the meatus (urinary opening) in either boys or girls. The insertion of parents' fingers into the foreskin, or even the handling of a baby's penis, could introduce bacteria into the preputial space of intact infants.
Parents should be careful not to [[Forced retraction|forcibly retract]] the [[foreskin ]] of a baby's penis, and to instruct the child's doctor and/or caretaker likewise. The act of forced retraction involves forcible separation that destroys a structural defense mechanism; the [[synechia]] which binds the foreskin to the glans is torn away, which allows E. coli to invade where it could not before.<ref name="Winberg 1989"/>
As [[circumcision ]] necessitates [[forced retraction]] of the foreskin, additionally creating an open wound that is vulnerable to additional infection, parents are advised against circumcision.<ref name="Outerbridge 1998"/> These functions suggest that the [[intact ]] prepuce may offer protection against UTI if undisturbed. The [[foreskin]] provides two physical lines of defense in the intact male child, which are removed in circumcision: the preputial sphincter, which closes when a boy is not urinating, and a protected meatus (urinary opening), which is often inflamed and open in circumcised boys.<ref name="Cunningham 1986"/> Recently, Fleiss et al. (1998) reviewed the immunological functions of the prepuce. In addition, the sub-preputial moisture contains lysosyme, which has an anti-bacterial action.<ref name="Fleiss 1998"/> Oligosaccharides excreted in the [[urine]] of breastfed babies prevent adhesion of pathogens to uroepithelial tissue.<ref name="Marild 1990"/>
== The UTI scare ==
Drs. Charles Ginsburg & George McCracken (1982) carried out a study of UTI in boys at [https://www.parklandhospital.com/ Parkland Hospital], a public hospital for indigent patients in Dallas, Texas. They reported that 95% of the boys in their study were not [[circumcised]],<ref name="ginsburg uti"/>, and this piqued the interest of US Army pediatrician [[Thomas E. Wiswell]].
In a determined search for an association between the presence of the [[foreskin]] and UTI, Wiswell et al. (1985) retrospectively examined charts of a number of boys born at U.S. military hospitals.<ref>{{REFjournal
|volume=32
|pages=130-134
}}</ref> Based on their observations of these old charts, they reported that [[Intactintact]] boys had a slightly higher rate of bacteriuria (bacteria in the [[urine]]) than circumcised boys during their first year of life, leading to the sensational statistic that [[circumcision]] resulted in a "ten to hundred times decrease in urinary tract infections in circumcised boys."
Wiswell's findings generated a great deal of controversy at the time. The prepuce (foreskin) is a protective organ, and one would not normally expect the removal of a healthy organ to reduce the risk of infections.<ref name="Cunningham 1986"/> Nevertheless, the apparent correlation of intact foreskin to bacteriuria (and hence UTI) prompted the American Academy of Pediatrics (AAP) to review the evidence available in 1989.
* It is very possible that the use of surgical antiseptic (to kill pathogenic organisms during the circumcision procedure itself) was in part responsible for the slight reduction in bacteriuria observed in these studies. This possibility was not accounted for in the studies.
* No information on rooming-in or breastfeeding history for the infants before they were hospitalized was recorded. [[Breastfeeding ]] and rooming-in are important factors in the prevention of UTI.<ref name="Winberg 1989"/> (See above.)
* Breastfeeding is a major confounding factor in any study of the role of circumcision in UTI. The Wiswell studies and all other studies in the literature fail to control for the effects of breastfeeding. The AAP observes that "breastfeeding status has not been evaluated systematically in studies assessing UTI and circumcision status."<<ref name="Sreenarasimhaiah 1998"/>
== Conclusion ==
The notion that [[circumcision]] is a useful prophylactic against UTI has been laid to rest by the 1999 AAP Task Force on Circumcision.<ref name="AAP 1999"/> Instead, healthy, natural alternatives such as [[breastfeeding ]] and rooming-in must be given favor. Breastfeeding offers a wide range of benefits for both mother and baby. Circumcision is surgery, and as such it has attendant risks, which includes UTI itself. The proper treatment of UTI, if it occurs, is antimicrobial.<ref name="McCracken 1989" />
Prevention of UTI is not regarded as a reason to circumcise a boy.
{{LINKS}}
* {{REFweb
|url=https://www.cirp.org/library/disease/UTI/
|title=Circumcision and urinary tract infection
|last=Anonymous
|first=
|init=
|publisher=Circumcision Reference Library
|date=2009-02-02
|accessdate=2023-04-20
}}
* {{REFweb
|url=http://www.gaamerica.org/symposia/first/altschul.html
|first=
|author-link=
|publisher=[[Doctors Opposing Circumcision(D.O.C.)]]
|website=
|date=2019
[[Category:Penile disorder]]
[[Category:Penile illness]]
[[Category:Breastfeeding]]
[[Category:From Intactipedia]]
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