Changes

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>Winberg J ''et al''. [http://www.cirp.org/library/disease/UTI/winberg-bollgren/ The Prepuce: A Mistake of Nature?] ''Lancet'' 1989, pp.598-99.</ref>

As circumcision necessitates [[forced retraction]] of the foreskin, additionally creating an open wound that is vulnerable to additional infection, parents are advised against circumcision. Recently, Fleiss et al. reviewed the immunological functions of the prepuce.<ref>Outerbridge EW. [http://www.cirp.org/library/disease/UTI/outerbridge/ Decreasing the risk of urinary tract infections]. (Letter). ''Paediatr Child Health'' 1998; 3(1):19.</ref> 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>Cunningham N. [http://www.cirp.org/library/disease/UTI/cunningham/ Circumcision and urinary tract infections]. (letter) ''Pediatrics'' 1986; 77(2):267.</ref> 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>Fleiss PM, Hodges FM, Van Howe RS. [http://www.cirp.org/library/disease/STD/fleiss3/ Immunological functions of the human prepuce]. ''Sex Trans Inf'' 1998: 364-367</ref> Oligosaccharides excreted in the urine of breastfed babies prevent adhesion of pathogens to uroepithelial tissue.<ref>Mårild S. [http://www.cirp.org/library/disease/UTI/marild/ Breastfeeding and Urinary Tract Infections]. ''Lancet'' 1990;336:942.</ref>

A number of studies in post-circumcision UTIs, and the role of the surgery in possibly facilitating UTIs, were not able to recommend neonatal circumcision.<ref>Altschul MS. [http://www.cirp.org/library/disease/UTI/altschul1990/ The circumcision controversy] (editorial). ''Am Fam Physician'' 1990;41:817-820.</ref><ref>Thompson RS: [http://www.cirp.org/library/disease/UTI/thompson/ Does circumcision prevent urinary tract infection? An opposing view]. ''J Fam Pract' 1990; 31: 189-96.</ref><ref>Bollgren I, Winberg J. Letter. ([http://www.cirp.org/library/disease/UTI/winberg-bollgren2/ Rebuttal of Edgar J. Schoen]) ''Acta Paediatrica Scandinavia'' 1991; 80:575-7.</ref><ref>Chessare JB. [http://www.cirp.org/library/disease/UTI/chessare/ Circumcision: Is the Risk of Urinary Tract Infection Really the Pivotal Issue?] ''Clinical Pediatrics'' 31(2):100-4, Feb. 1992. Department of Pediatrics, Medical College of Ohio, Toledo 43699.</ref> Significantly, a number of recent Israeli studies have reported an increase in urinary tract infection rates in the period following ritual circumcision.<ref>Amir J. ''et al.'' [https://jamanetwork.com/journals/jamapediatrics/article-abstract/513140 Circumcision and Urinary Tract Infections in Infants]. ''Am J Dis Child'' (1986), vol. 140, p. 1092.</ref><ref>Cohen, H. ''et al.'' [http://www.cirp.org/library/disease/UTI/cohen/ Postcircumcision Urinary Tract Infection]. ''Clinical Pediatrics'' (1992), pp. 322-4.</ref><ref>Goldman M, Barr J, Bistritzer T, Aladjem M. [http://www.cirp.org/library/disease/UTI/goldman/ Urinary tract infection following ritual jewish circumcision]. ''Israel Journal of Medical Sciences'' 1996;32(11),1098-102.</ref><ref>Van Howe RS. [http://www.cirp.org/library/disease/UTI/vanhowe_uti2005/ Effect of confounding in the association between circumcision status and urinary tract infection]. ''J Infect'' 2005;51(1):59-68.</ref> In a prospective study, Kayaba et al. found a zero incidence of UTI in 603 intact boys, over a range of ages.<ref>Kayaba H ''et al.'' [http://www.cirp.org/library/normal/kayaba/ Analysis of shape and retractability of the prepuce in 603 Japanese boys]. ''J Urol'', 1996 Nov, V156 N5:1813-5.</ref> Although this study did not focus on UTI, the Japanese researchers concluded: "Awareness of these findings will eliminate unnecessary circumcision in boys."