ERRATA

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.

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Circumcision

PEDIATRICS ◽

10.1542/peds.85.5.889 ◽

1990 ◽

Vol 85 (5) ◽

pp. 889-889

Author(s):

EDGAR J. SCHOEN

Keyword(s):

Urinary Tract ◽

American Academy ◽

Urinary Tract Infections ◽

Task Force ◽

New Born ◽

Advantages And Disadvantages ◽

American Academy Of Pediatrics ◽

Tract Infections

In Reply.— Dr Wiswell essentially agrees with the content and documentation of the report of the Task Force on Circumcision. However, he believes that the benefits of newborn circumcision outweigh the risks, whereas our report simply pointed out the advantages and disadvantages of circumcision without taking a position for or against the procedure. The points in Wiswell's letter are well taken. His work on the increased risks of urinary tract infections (UTIs) in uncircumcised male infants had an important role in the decision of the American Academy of Pediatrics to convene our Task Force and review its position on new-born circumcision.

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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.

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Urinary Tract Infections and the Uncircumcised State: An Update

Clinical Pediatrics ◽

10.1177/000992289303200301 ◽

1993 ◽

Vol 32 (3) ◽

pp. 130-134 ◽

Cited By ~ 110

Author(s):

Thomas E. Wiswell ◽

Wayne E. Hachey

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Meta Analysis ◽

Fold Increase ◽

First Year ◽

Us Army ◽

Increased Risk ◽

Army Hospitals ◽

Tract Infections ◽

First Year Of Life

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.

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Diagnosis and Management of UTI in Febrile Infants Age 0–2 Months: Applicability of the AAP Guideline

Journal of Hospital Medicine ◽

10.12788/jhm.3349 ◽

2020 ◽

pp. 176-180

Author(s):

Pearl W Chang ◽

Marie E Wang ◽

Alan R Schroeder

Keyword(s):

Clinical Practice ◽

Urinary Tract ◽

American Academy ◽

Urinary Tract Infections ◽

Clinical Practice Guideline ◽

Age Group ◽

Routine Testing ◽

Young Infants ◽

American Academy Of Pediatrics ◽

Tract Infections

Urinary tract infections (UTIs) are the most common bacterial infection in young infants. The American Academy of Pediatrics’ (AAP) clinical practice guideline for UTIs focuses on febrile children age 2-24 months, with no guideline for infants <2 months of age, an age group commonly encountered by pediatric hospitalists. In this review, we assess the applicability of the AAP UTI Guideline’s action statements for previously healthy, febrile infants <2 months of age. We also discuss additional considerations in this age group, including concurrent bacteremia and routine testing for meningitis.

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Risks From Circumcision During the First Month of Life Compared With Those for Uncircumcised Boys

PEDIATRICS ◽

10.1542/peds.83.6.1011 ◽

1989 ◽

Vol 83 (6) ◽

pp. 1011-1015

Author(s):

Thomas E. Wiswell ◽

Dietrich W. Geschke

Keyword(s):

Renal Failure ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Tract Infections ◽

Surgical Trauma ◽

Us Army ◽

Army Hospitals ◽

Tract Infections

The records of 136,086 boys born in US Army hospitals from 1980 to 1985 were reviewed for indexed complications related to circumcision status during the first month of life. For 100,157 circumcised boys, there were 193 complications (0.19%). These included 62 local infections, eight cases of bacteremia, 83 incidences of hemorrhage (31 requiring ligature and three requiring transfusion), 25 instances of surgical trauma, and 20 urinary tract infections. There were no deaths or reported losses of the glans or entire penis. By contrast, the complications in the 35,929 uncircumcised infants were all related to urinary tract infections. Of the 88 boys with such infections (0.24%), 32 had concomitant bacteremia, three had meningitis, two had renal failure, and two died. The frequencies of urinary tract infection (P < .0001) and bacteremia (P < .0002) were significantly higher in the uncircumcised boys. Serious complications from routine prepuce removal are rare and relatively minor. Circumcision may be beneficial in reducing the occurrence of urinary tract infections and their associated sequelae.

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