Urinary Tract Infections and the Uncircumcised State: An Update

In a two-part study of the circumcision status of boys with urinary tract infections (UTIs), we reviewed the occurrence of UTIs in 209,399 infants born in US Army hospitals worldwide from 1985 to 1990. During the first year of life, 1,046 (0.5%: 550 girls and 496 boys) were hospitalized for UTIs. Noncircumcised male infants had a 10-fold greater incidence of infection than did circumcised male infants. The frequency rate of circumcision rose significantly, from 70.3% to 80.2%, during the study period. Among uncircumcised boys younger than 3 months with UTIs, 23% had concomitant bacteremia involving the same organism. The second part of the study consisted of a meta-analysis of all nine previous reports on the circumcision status of boys with UTIs. These studies revealed a fivefold to 89-fold increased risk of infection in uncircumcised boys; the combined data yielded a 12-fold increase in UTIs in this population. Parents should be told of the lower risk of UTIs for circumcised boys during informed-consent counseling.

Download Full-text

Corroborative Evidence for the Decreased Incidence of Urinary Tract Infections in Circumcised Male Infants

PEDIATRICS ◽

10.1542/peds.78.1.96 ◽

1986 ◽

Vol 78 (1) ◽

pp. 96-99 ◽

Cited By ~ 7

Author(s):

Thomas E. Wiswell ◽

John D. Roscelli

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Tract Infections ◽

First Year ◽

Us Army ◽

Army Hospitals ◽

Corroborative Evidence ◽

Tract Infections ◽

First Year Of Life

We report the results of a two-part study examining the incidence of urinary tract infection during the first year of life. In the first part of the investigation, we reviewed the occurrence of urinary tract infection in a cohort of 3,924 infants born at our institution during a 4-year period. Infection developed in 16 infants (0.41%). The incidence of urinary tract infection in noncircumcised males was greater than the incidence in both female (P < .004) and circumcised male (P < .001) infants. In the second part of the study, we explored the frequency of urinary tract infection in all infants born in US Army hospitals, worldwide, over a 10-year period. There were 422,328 infants born in army facilities during this time period. Subsequent hospitalization for urinary tract infection occurred for 1,825 (0.43%) infants during the first year of life. Overall, there was no male preponderance for infections in early infancy compared with females. After an equivalent incidence during the first month of life, female infants had significantly more infections than did male infants (P < .001). However, noncircumcised male infants had a higher incidence of urinary tract infection than female infants (P < .001). Additionally, noncircumcised male infants had a tenfold greater incidence of infection than circumcised male infants (P < .001). There was a significant decrease in the circumcision frequency rate during the 10-year study period (from 85.4% to 73.9%, P < .001). As the number of circumcisions decreased, there was a concomitant increase in the overall number of urinary tract infections in males (P <.02). A reduced incidence of infection may be at least one medical benefit of routine neonatal circumcision.

Download Full-text

Circumcision

PEDIATRICS ◽

10.1542/peds.80.2.303 ◽

1987 ◽

Vol 80 (2) ◽

pp. 303-304

Author(s):

ROBERT S. THOMPSON ◽

DIANE C. THOMPSON

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Retrospective Cohort ◽

Fold Increase ◽

First Year ◽

Discharge Data ◽

Army Hospitals ◽

Retrospective Cohort Studies ◽

Tract Infections ◽

First Year Of Life

To the Editor.— Wiswell et al,1 in 1985, and Wiswell and Roscelli,2 in 1986, report three retrospective cohort studies (Tripler, Brooke, and all Army hospitals) in which the association of circumcision status (circumcised v noncircumcised) and subsequent hospitalizations for urinary tract infection in the first year of life is evaluated. Cases appear to have been determined from examination of available hospital discharge data and the diagnosis confirmed by suprapubic bladder tap or catheterization. The authors report a ten- to 20-fold increase in hospitalized urinary tract infections among noncircumcised boys in the first year of life.

Download Full-text

Circumcision and Urinary Tract Infections

PEDIATRICS ◽

10.1542/peds.77.2.267a ◽

1986 ◽

Vol 77 (2) ◽

pp. 267-269

Author(s):

THOMAS E. WISWELL

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

First Year ◽

Tract Infections ◽

First Year Of Life

In Reply.— Dr Cunningham apparently believes that there is no plausible physiologic explanation for the association between a decreased incidence of urinary tract infections and circumcisions as we recently described,1 and that we should seek alternative explanations for our findings. However, we disagree with most of the alternative suggestions and the comments that he has made. We recently completed a second study evaluating the occurrence of urinary tract infections during the first year of life in more than 400,000 infants.

Download Full-text

ERRATA

PEDIATRICS ◽

10.1542/peds.84.5.761 ◽

1989 ◽

Vol 84 (5) ◽

pp. 761-761

Keyword(s):

Urinary Tract ◽

American Academy ◽

Urinary Tract Infections ◽

Task Force ◽

Expert Advice ◽

Us Army ◽

American Academy Of Pediatrics ◽

Tenfold Increase ◽

Army Hospitals ◽

Tract Infections

In the American Academy of Pediatrics' "Report of the Task Force on Circumcision" (Pediatrics. 1989;84:388-391), on page 389, "Urinary Tract Infections," the second sentence should read: "Beginning in 1985, studies conducted at US Army hospitals involving more than 200 000 infant boys [not men] showed a greater than tenfold increase in urinary tract infections in uncircumcised compared with circumcised male infants;. . . ." In addition, the Task Force wishes to acknowledge the following for their provision of expert advice: David T. Mininberg, MD, Urology Section Liaison, Jerome O Klein, MD, and Edward A Mortimer, Jr, MD.

Download Full-text

Larger Numbers Needed

PEDIATRICS ◽

10.1542/peds.80.5.764 ◽

1987 ◽

Vol 80 (5) ◽

pp. 764-764

Author(s):

THOMAS E. WISWELL

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Tract Infections ◽

First Year ◽

Infection Rates ◽

Symptomatic Urinary Tract Infection ◽

Tract Infections ◽

First Year Of Life

In Reply.— Dr Altschul presents data on urinary tract infections during infancy and reports infection rates substantially lower than those we have previously reported.1,2 He then makes several conclusions based on these differences. His data indicate that the maximum infection rates would be 0.11% among girls and 0.02% and 0.12% among circumcised and uncircumcised boys, respectively. In contrast, from a population of 422,328 infants, we found the overall incidence of symptomatic urinary tract infection during the first year of life to be 0.57% in girls, 0.11% in circumcised boys, and 1.12% in uncircumcised boys.

Download Full-text

Decreased Incidence of Urinary Tract Infections in Circumcised Male Infants

PEDIATRICS ◽

10.1542/peds.75.5.901 ◽

1985 ◽

Vol 75 (5) ◽

pp. 901-903 ◽

Cited By ~ 4

Author(s):

THOMAS E. WISWELL ◽

FRANKLIN R. SMITH ◽

JAMES W. BASS

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Tract Infections ◽

Male Infant ◽

Large Cohort ◽

First Year ◽

Tract Infections ◽

First Year Of Life ◽

Increased Susceptibility

In a recent report of 100 infants less than 8 months of age with urinary tract infection, it was noted that 95% of the male infants were not circumcised.1 The authors speculated from this observation that the uncircumcised male infant may have an increased susceptibility to urinary tract infection, but commented that the incidence of urinary tract infection in uncircumcised compared with circumcised infants was unknown. We report the results of a study documenting the incidence of unnary tract infection during the first year of life in a large cohort of infants born at our institution over an 18-month period and we also document the incidence of urinary tract infection in circumcised compared with uncircumcised male infants.

Download Full-text