Urinary tract infection: Difference between revisions
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|date=1975 | |date=1975 | ||
|volume=47 | |volume=47 | ||
}}</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> Two interventions that put the male infant at immediate risk for UTIs are [[circumcision]],<ref>{{REFjournal | ||
|last=Smith | |||
|init=RM | |||
|url=http://www.cirp.org/library/disease/UTI/smith1916/ | |||
|title=Recent contributions to the study of pyelitis in infancy | |||
|journal=Am J Dis Child | |||
|date=1916 | |||
|volume=XII | |||
|pages=235.243 | |||
}}</ref> 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 | |||
|last=Winberg | |last=Winberg | ||
|init=J | |init=J | ||
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|issue=2 | |issue=2 | ||
|page=267 | |page=267 | ||
}}</ref> Urinary tract infections (UTI) are a [[complication]] of [[circumcision]] | }}</ref> Urinary tract infections (UTI) are a [[complication]] of [[circumcision]] in [[Israel]].<ref name="Cohen 1992">{{REFjournal | ||
|last=Cohen | |last=Cohen | ||
|init=H | |init=H | ||
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|last=Wiswell | |last=Wiswell | ||
|init=TE | |init=TE | ||
|author-link=Thomas E. Wiswell | |||
|last2=Smith | |last2=Smith | ||
|init2=FR | |init2=FR | ||
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|last=Wiswell | |last=Wiswell | ||
|init=TE | |init=TE | ||
|author-link=Thomas E. Wiswell | |||
|title=Circumcision and urinary tract infections | |title=Circumcision and urinary tract infections | ||
|journal=Pediatrics | |journal=Pediatrics | ||
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|last=Wiswell | |last=Wiswell | ||
|init=TE | |init=TE | ||
|author-link=Thomas E. Wiswell | |||
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|last=Wiswell | |last=Wiswell | ||
|init=TE | |init=TE | ||
|author-link=Thomas E. Wiswell | |||
|last2=Enzenauer | |last2=Enzenauer | ||
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|last=Wiswell | |last=Wiswell | ||
|init=TE | |init=TE | ||
|author-link=Thomas E. Wiswell | |||
|last2=Geschke | |last2=Geschke | ||
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|last=Wiswell | |last=Wiswell | ||
|init=TE | |init=TE | ||
|author-link=Thomas E. Wiswell | |||
|title=Routine neonatal circumcision: a reappraisal | |title=Routine neonatal circumcision: a reappraisal | ||
|journal=Am Fam Physician | |journal=Am Fam Physician | ||
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|last=Wiswell | |last=Wiswell | ||
|init=TE | |init=TE | ||
|author-link=Thomas E. Wiswell | |||
|last2=Hachey | |last2=Hachey | ||
|init2=WE | |init2=WE | ||
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}}</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." | }}</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. | 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. | ||
=== Confounding factors to Wiswell's work === | === Confounding factors to Wiswell's work === | ||
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|issue=1 | |issue=1 | ||
|pages=123-132 | |pages=123-132 | ||
}}</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. | }}</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. | ||
Wiswell's retrospective reviews of old hospital records failed to take a few factors into account: | Wiswell's retrospective reviews of old hospital records failed to take a few factors into account: | ||
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}}</ref> There is a significant false-positive rate in diagnosing UTI when [[urine]] cultures alone are used.<ref name="Mueller 1997"/><ref name="Saez-Llorens 1989"/> This criticism was addressed to some extent in Wiswell's second review.<ref name="Wiswell 1986"/> | }}</ref> There is a significant false-positive rate in diagnosing UTI when [[urine]] cultures alone are used.<ref name="Mueller 1997"/><ref name="Saez-Llorens 1989"/> This criticism was addressed to some extent in Wiswell's second review.<ref name="Wiswell 1986"/> | ||
* 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 | * 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 | ||
|last=O'Brien | |last=O'Brien | ||
|init=TR | |init=TR | ||
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|issue=88 | |issue=88 | ||
|pages=411-415 | |pages=411-415 | ||
}}</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 | }}</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 | ||
|last=Van Howe | |last=Van Howe | ||
|init=RS | |init=RS | ||
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* 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.) | * 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"/> | * 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"/> | ||
=== Even if... === | === Even if... === | ||
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|accessdate=2019-10-20 | |accessdate=2019-10-20 | ||
|quote= | |quote= | ||
}} | |||
* {{REFweb | |||
|url=https://www.reddit.com/r/foreskinexplained/comments/1n27851/uti_risks_for_circumcised_vs_intact_vs_females/ | |||
|title=UTI risks for circumcised vs intact vs females | |||
|last=Anonymous | |||
|first= | |||
|init= | |||
|author-link= | |||
|publisher=REDDIT | |||
|date=2025-08-28 | |||
|accessdate=2025-08-28 | |||
}} | }} | ||