ArticlesCohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection
Introduction
Circumcision for infant boys remains controversial, but it is still a common-procedure. About one in six boys and men in the world has been circumcised, in most cases for religious reasons.1 The medical reasons most commonly given for circumcision of infant boys are: to prevent phimosis, paraphimosis, and balanitis; to decrease the risk of cancer of the penis; and to decrease the risk of urinarytract infection (UTI) among infants.
According to the US National Center for Health Statistics, 61% of the 1·95 million boys born during 1987 in the USA were circumcised; thus, circumcision was the commonest surgical procedure done in boys in the USA.2 A declining tend has been observed by Wiswell, who reported that the proportion of infants circumcised in US military hospitals, involving a large, widely dispersed population, had substantially decreased, from about 85% in 1975 to about 70% 9 years later. During the late 1980s, there was an increase in the rate of circumcision. The rate of circumcision in 1970 was 48% in Canada, 24% in the UK, and 70% in Australia.4 Based on in-hospital circumcision of infants younger than 28 days old in Ontario during 1985–95, the rate in the province remained almost constant at 35%.5 After a sharp increase in the rate of circumcision in 1991 (from 35% to 42%) there was a slow decline to 30% by 1995.
Most previous studies, with case-control designs, compared the rate of UTI in the first year of life among circumcised and uncircumcised boys. Although these studies suggested a protective effect of circumcision on the risk of UTI in boys, they did not follow up children prospectively to observe the risk of subsequent UTI. Questions remain about both short-term and long-term benefits of circumcision. We used population-based data to follow up circumcised and uncircumcised boys for up to 3 years from birth. Their risk of UTI was calculated and compared by life-table and cohort analyses.
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Study population
Computerised data from the Canadian Institute for Health Information on hospital discharges in Ontario were used for fiscal years 1993–94 to 1995–96 (April 1 to March 31 of the following year). Collection of hospital discharge data for submission to the Institute is mandatory for all hospitals in Canada. Data are collected on all patients discharged from public, private, and federal hospitals in Ontario, including acute-care and chronic-care hospitals and acute psychiatric hospitals. Therefore,
Results
69 100 eligible infant boys were included in the study. 30 105 (43·6%) were circumcised and 38 995 uncircumcised. Of the circumcised boys, almost all (29 217 [97·1%]) underwent the procedure during the first month of life. The 888 boys who were circumcised after the first month of life were excluded. No infant had UTI before his circumcision. Of the 38 995 uncircumcised boys, 29 217 were matched to boys in the circumcised cohort by date of birth. Since the birth cohort includes babies who were
Discussion
A substantially lower incidence of UTI among circumcised boys has been cited as one of the major benefits of circumcision. In 1982, Ginsburg and McCracken8 reported an inverse association between UTI and circumcision in infant boys based on 109 UTI cases, of which 95% were in uncircumcised boys. Subsequent studies have confirmed a higher rate of UTI in uncircumcised than in circumcised boys (table 2).
Since rate of admission for UTI is low, a large number of participants is required to show any
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2021, International Journal of Infectious DiseasesCitation Excerpt :The most likely reason is the high prevalence of phimosis among Japanese males (Hayashi et al., 2010); because bacteria preferentially colonize the preputium and can spread to the urethral meatus, phimosis becomes a major risk factor for fUTI during infancy (Rushton and Majd, 1992; Hiraoka et al., 2002). Circumcision of the prepuce decreases meatal contamination and has been found to decrease the incidence of UTI in infants from 1/4 to 1/20 (To et al., 1998; Wiswell et al., 1985). However, the circumcision of infants is seldom performed in Japan (Hayashi et al., 2010).
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2019, Journal of Pediatric UrologyCitation Excerpt :Infant males who are uncircumcised are known to be at increased risk for urinary tract infection (UTI) compared with males who are circumcised [1–8].