ostrove@umd5 (Steve Ostrove) (10/17/86)
The following is taken from the Aug 1986 issue of Pediatric Update. It is reprinted without their permission. It may prove interesting to those who have questions about circumcision. SACRAMENTO -- The risk of urinary tract infection is markedly increased in uncircumcised male infants. Dr. Stephen R. Shapiro said at a symposium on pediatric infectious disease sponsored by the University of California, Davis, School of Medicine and the Sacramento Pediatric Society. In one study, uncircumcised male infants were found to have an incidence of uninary tract infection (UTI) 20 times that of female or circumcised infants, said Dr. Shapiro, of the university and in private practice in Sacramento. Of 5,261 infants studied (more than half of them girls), 28 of the 41 with documented UTI were male; all but four were uncircumcised. In a 1982 study, 100 infants were followed from birth. Just one of the 11 males who developed clinical UTI had been circumcised: 7% of the male infants and 45% of the female infants with UTI had radiographic abnormalities of the urinary system. Circumcision may reduce the extent of meatal contamination and thus decrease the likelihood of bacterial ascent into the bladder, but data are insufficient to affect recommendations concerning circumcision, Dr. Shapiro commented. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics joint statement regarding circumcision notes that "there is no absolute medical indication for routine circumcision," he said. It is unclear whether the increased incidence of UTI among uncircumcised infants will have long-term medical significance other than immediate cost of diagnosis, treatment, and follow-up of the acute infection. It also is not known if these children will have more long-term urologic problems, Dr. Shapiro said. Generally, boys eith UTI are more likely than girls to have an anatomic abnormality, but UTI in boys has generally received little attention because its incidence is lower, the investigator said. In a study of 83 boys, aged 2 weeks to 14 years, presenting at Boston Children's Hospital with a first known UTI, 62 had an anatomic abnormality. The most common was vesicoureteral reflux (46 cases), but more than one-fourth had obstructive lesions. The most common organisms encountered were gram-positive bacteria, suggesting a hematogenous rather than an ascending route, Dr. Shapiro said. -- Steve Ostrove University of Maryland CSC PC/IP/Net Project usenet: ...!seismo!cvl!umd5!ostrove ARPA: ostrove@umd5.umd.edu BITNET: ostrove@umdd