Urinary tract infection: Difference between revisions

A '''urinary tract infection''', also commonly known as a '''UTI''', is a bacterial infection in the urinary tract (kidneys, ureters, bladder and/or [[urethra]]). UTIs can affect both males and females, although, due to the difference in structures of the male and female urinary tract, infections occur most commonly in girls and women, as the urinary tract is shorter in females than it is in males. UTIs can become serious if undetected, and may lead to permanent kidney damage. However, they are easily and effectively treated with antibiotics.<ref name="ginsburg uti">{{REFjournal

}}</ref><ref name="McCracken 1989">{{REFjournal

}}</ref> Although ''E. coli'' is one of the most common bacteria on the surface of human [[skin]], strains found in hospitals tend to be particularly virulent. ''E. coli'' that live in the intestinal tract cause urinary tract infections when allowed to get into the sterile urinary tract. Whether intact or circumcised, baby boys sitting in poopy diapers allows ''E. coli'' an opportunity to enter the urinary tract. And, of course, fiddling with the foreskin and introducing bacteria foreign to the baby's body or his urinary tract can cause UTI, too. The tight [[foreskin]] of the infant boy acts as a sphincter to allow [[urine]] to flow out, but prevents contaminants and pathogens from coming in.<ref name="Fleiss 1998">{{REFjournal

|date=1998-10

}}</ref>

}}</ref> Two interventions that put the male infant at immediate risk for UTIs are [[circumcision]], which removes the protection of the [[foreskin]], and [[forced retraction]] of the foreskin. These interventions tear away the synechia which binds the foreskin to the [[glans]] in male infants, thereby creating entry points for ''E. coli'' bacteria,<ref name="Winberg 1989">{{REFjournal

}}</ref> which binds to the glans penis of the infant.<ref name="Cunningham 1986">{{REFjournal

}}</ref> Urinary tract infections (UTI) are a complication of circumcision.<ref>{{REFjournal

|title=Recent contributions to the study of pyelitis in infancy

|pages=235.243

}}</ref><ref name="Cohen 1992">{{REFjournal

The most common way of relieving a urinary tract infection is the administration of antibiotics,<ref name="ginsburg uti"/> if the infection does not clear up on its own.

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It was determined in the 1990s that breastfeeding plays a central role substantially reducing the incidence of UTIs.<ref name="Winberg 1989"/><ref>{{REFjournal

}}</ref> Outerbridge (1998) pointed out that breastfeeding is very effective in reducing incidence of UTI in both boys and girls.<ref name="Outerbridge 1998">{{REFjournal

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"/>

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

}}</ref> Based on their observations of these old charts, they reported that Intact 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.

}}</ref> so the majority of its young male client population would have necessarily remained intact. The observation that 95% of the boys were not circumcised, therefore, indicated nothing more than that the majority of male infant patients at Parkland Hospital were not circumcised.

* The hospital chart data used in the retrospective studies are unreliable. Hospitals frequently omit to record a circumcision on a baby's chart. In Atlanta, O'Brien found that circumcision was recorded only 84.3% of the time for circumcised boys.<ref>{{REFjournal

}}</ref> If the records used in the retrospective bacteriuria studies are similarly inaccurate, then a statistically significant number of the infants with bacteriuria that were claimed to be intact were, in fact, circumcised. This would naturally overstate the rate of infection in intact boys.<ref>{{REFjournal

* 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"/>

Wiswell's sensational statistic, that circumcision resulted in a "ten to hundred times decrease in urinary tract infections in circumcised boys," has often been quoted; however, it is misleading. In fact, UTIs are so rare in either case that,even giving Wiswell's data the benefit of the doubt, 50 to 100 healthy boys would have to be circumcised in order to prevent a UTI from developing in only one patient. Using more recent data from a better-controlled study, the number of unnecessary operations needed to prevent one hospital admission for UTI would jump to 195.<ref>{{REFjournal

}}</ref> In a prospective study, Kayaba et al. found a zero incidence of UTI in 603 intact boys, over a range of ages.<ref>{{REFjournal

The American Academy of Pediatrics (AAP) formed a 1989 task force under the chairmanship of the late [[Edgar J. Schoen]] to reconsider its 1975 policy statement. This task force issued a statement in 1989 which cited the UTI papers of [[Thomas E. Wiswell]] as a reason that one might circumcise a child., but it included a disclaimer. The report stated:

The American Academy of Pediatrics (AAP) has issued two statements which, when read together, constitute a substantial change in AAP policy toward the prevention of UTI in infants. First, in 1997, the AAP Workgroup on Breastfeeding recommended breastfeeding as highly beneficial in preventing a wide range of infections including UTI.<ref name="AAP 1997">{{REFjournal

The 1999 AAP Task Force on Circumcision did, however, declare that breastfeeding produces a three fold reduction in UTI in infants. Two separate panels of the AAP, the Work Group on Breastfeeding and the 1999 Task Force on Circumcision, now recommend breastfeeding to reduce incidence of UTI.<<ref name="AAP 1997"/><ref name="AAP 1999"/>

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 include UTI itself.

  |publisher=Genital Autonomy America

  |publisher=Doctors Opposing Circumcision