Should Boys be Circumcised?

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Fimbriated E. coli, found in the alimentary canal of humans and other animals, is by far the most common cause of urinary tract infection (UTI). The foreskin has a whorl of muscle fibers at the opening that act as a sphincter, closing the foreskin and keeping feces from entering the urethra. Sterile urine flushes out the foreskin every time the infant urinates. Circumcision destroys nature’s protective device.

Breastfeeding is another protective device because substances in breast milk prevent the p-fimbriated E. coli from adhering to the urethra. Studies from the mid-1980s were carried out before anyone was aware of the protective effect of breastfeeding. Consequently, no one controlled for breastfeeding or other confounding factors when these circumcision studies were done.

The American Academy of Pediatrics agrees with us. It recommends breastfeeding to prevent UTI but does not recommend circumcision.[1]  It also recommends avoiding “procedures that may interfere with breastfeeding or that may traumatize the infant,”[1] This, of course, includes non-therapeutic neonatal circumcision.

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More of the same Grooucho Marx- “Who are you going to believe NOCIRC or the published scientific evidence”. I explained the evidence, and you’ve heard the NOCIRC “counter”- opinions, anecdotes and myths. So let’s go to some of the references themselves.

1.     Wiswell TE. John K. Lattimer lecture. Prepuce presence portends prevalence of potentially perilous periurethral pathogens. J Urol 148:739-742, 1992.

2.    Fussell EN, Kaack MB, Cherry R, Roberts JA. Adherence of bacteria to human foreskins. J Urol 140:997-1001, 1988.

3.    Spach DH, Stapleton AE, Stamm WE. Lack of circumcision increases the risk of urinary tract infection in young men. JAMA 267:679-681, 1992.

4.    Shaw KN, Gorelick M, McGowan KL, Yakscoe NM, Schwartz JS. Prevalence of urinary tract infection in febrile young children in the emergency department. Pediatrics 102:E16, 1998.

5.    Schoen EJ, Colby CJ, Ray GT. Newborn circumcision decreases incidence and costs of urinary tract infections during the first year of life. Pediatrics 105:789-793, 2000.

6.    Rushton HG, Majd M, Jantausch B, Wiedermann BL, Belman AB. Renal scarring following reflux and nonreflux pyelonephritis in children: evaluation with 99mtechnetium-dimercaptosuccinic acid scintigraphy [published erratum appears in J Urol, 148:898, 1992]. J Urol 47:1327-1332, 1992.

7.    Stokland E, Hellstrom M, Jacobsson B, Jodal U, Sixt R. Renal damage one year after first urinary tract infection: role of dimercaptosuccinic acid scintigraphy. J Pediatr 129:815-820, 1996.

8.    Craig JC, Knight JF, Sureshkumar P, Mantz E, Roy LP. Effect of circumcision on incidence of urinary tract infection in preschool boys. J Pediat 1996; 128: 23-27.

9.    To T, Agha M, Dick PT, Feldman W. Cohort study on circumcision of newborn boys and subsequent risk of urinary tract infection. Lancet 1998; 352: 1113-1116.

10.    Wiswell TE. The prepuce, urinary tract infections, and the consequences. Pediatrics 2000; 105: 8602.

11.    Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first febrile urinary tract infection in young children.
N Engl J Med. 2003 Jan 16;348(3):195-202.
  16a.  Zorc JJ, Levine DA, Platt SL, Dayan PS, Macias CG, Krief W, Schor J, Bank D, Shaw KN, and Kuppermann N. Clinical and demographic factors associated with urinary tract infection in young febrile infants. Pediatrics 2005; 116: 644-648.
 
12.    Kalcev B. Circumcision and personal hygiene in school boys. Med Officer 112:171-173, 1964.

13.    Oster J. Further fate of the foreskin: incidence of preputial adhesions, phimosis, and smegma among Danish school-boys. Arch Dis Child 43:200-203, 1968.

14.    Escala JM, Rickwood AM. Balanitis. Br J Urol 63:196-197, 1989.

15.    Frank R. Circumcision and hygiene in geriatric patients [letter]. J Am Geriatr Soc 47:1155, 1999.

16.    Mallon E, Hawkins D, Dinneen M, Francics N, Fearfield L, Newson R, C Bunker. Circumcision and genital dermatoses. Arch Dermatol 136:350-354, 2000.

There you have it. Overwhelming data showing a protection against infant UTIs of about tenfold (1000%). Not only that, but there is a good chance of getting later scarring of the kidneys with infant UTIs. The way that the infecting bacteria attach to the foreskin is shown in electron microscopic photos. The references on foreskin infections, mechanical problems, and skin disorders are also included. Check them out. Almost impossible to see how NOCIRC can deny the facts but they continue with the opinions, arguments and myths, ignoring the science.