The Link between Circumcision and Urinary-Tract Infections (UTI)

Summary of Research Results

(To be added)

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Medical Articles and Abstracts

Can circumcision prevent recurrent urinary tract infections in
hospitalized infants?

D.L. Cason , B.S. Carter and J. Bhatia
Clin Pediatr (Phila) 2000 Dec;39(12):699-703

Urinary tract infection (UTI) is an uncommon but concerning condition for hospitalized premature infants. A retrospective chart review of all male infants admitted to the neonatal intensive care unit (NICU) from June 1996 through March 1999 was conducted at the Medical College of Georgia--a large academic medical center with a tertiary Level III NICU--to investigate the frequency and potential prevention of recurrent UTI in hospitalized infants.

The effect of circumcision on recurrence of UTI was also investigated. There were 38 infants with 53 UTIs among 744 male infants admitted during the study period (5.1%). Infants were divided into two groups: A1 <37 weeks with a single UTI and A2 <37 weeks with more than one UTI. In groups A1 and A2, 57% of the first UTIs were due to Candida or E. coli, the remaining were due to other gram- negative organisms and Staphylococcus species. Mean gestational age (GA) in groups A1 and A2 were similar (29 +/- 2 weeks, and 29 +/- 4 weeks); however, mean GA of infants with Candida UTI was 27 +/- 2 weeks, and for bacterial UTI, 30 +/- 3 weeks (p<0.01).
None of the premature infants in the study had a recurrent UTI once a
circumcision was performed. Premature uncircumcised males had an
increased risk for UTI (Odds Ratio=11.1, 95% CI, 3.3-28.9, p<0.001).
Circumcision appears beneficial in reducing the risk for recurrent
UTI in these infants.

Infant Bladder Infection Common
Reuters Health, New York, May 19, 1997. Dr.Thomas Newmon, Professor of Pediarics, University of California San Francisco (UCSF)

"More than 1 in 10 babies with fever going to the pediatrician may be suffering from--often undiagnosed--urinary tract infections(UTIs) experts say.
"We know that fever in this age group can be due to life threatening illness, but most of these babies have colds or other mild illnesses that get better themselves, said Dr. Thomas Newman, an associate professor of pediatrics at the University of California San Francisco (USCF). He believes "the difficult issue is how to identify the few babies needing treatment without doing lots of unecessary test on all remaining infants."

Newman and his USCF colleagues suspected that UTIs might be more prevalent among infants 3 months of age than generally thought.

They canvassed over 200 pediatricians involved in the Pediatric Research in Office Settings (PROS) Network, affiliated with the American academy of Pediatrics
The researchers perused the records of nearly 900 babies who were brought to PROS clinics after experiencing unexplained fever. Less than half of those infants were asked to give urine to be tested for bacterial infection.
But of those 420 infants who were evaluated via urine sample, 50 (11%) tested positive for bladder infection.

Seven of those 50 infants had concurrent bacterial infection (septicemia), which can be dangerous- and in some cases, even fatal. Many bacterial blood infections might not initially present with severe symptoms, however-in fact, only four of the seven babies appeared to be more than "slightly ill", according to the UCSF report. And none of those (clinically) ill infants displayed feverish symptoms while in the pediatrician's office, though their temperatures did rise when home.

"Evaluation of fever in infants less than 3 months old is a major challenge," Newman admits.

He believes that, since UTI symptoms can be either subtle or nonexistent, a routine urine test becomes imperative in infants presenting with fever.

In a related finding, researchers discovered that the strongest risk factor for infant UTI was being an uncircumcised male. Those babies were found to have 10 times the infection rate of their circumcised counterparts.

Newman presented his findings at the recent annual meetings of the Pediatric Academic Societies in Washington, D.C.

Corroborative Evidence For the Decreased Incidence Of Urinary Tract Infections In Circumcised Male Infants
Wiswell TE, Roscelli JD Pediatrics 1986: 78; 96-99

In a worldwide study of all male infants born in U.S. Army hospitals over a ten year period "... noncircumcised male infants had tenfold greater incidence of infection than circumcised male infants. As the number of circumcisions decreased over the ten year period from 85% to 74%, there was a concommitant increase in the overall number of urinary tract infections in males"

Newborn Circumcision Decreases Incidence and Costs of Urinary Tract Infections During the First Year of Life.
Schoen EJ, Colby CJ, Ray GT

Departments of Genetics and Pediatrics, Kaiser Permanente Medical Care Program of Northern California, Oakland, California.

[Record supplied by publisher]

Objective. To assess the effect of newborn circumcision on the incidence and medical costs of urinary tract infection (UTI) during the first year of life for patients in a large health maintenance organization. Setting. Kaiser Permanente Medical Care Program of Northern California (KPNC). Patients. The population consisted of members of KPNC. The study group consisted of a cohort of 28 812 infants delivered during 1996 at KPNC hospitals; of the 14 893 male infants in the group, 9668 (64.9%) were circumcised. A second cohort of 20 587 infants born in 1997 and monitored for 12 months was analyzed to determine incidence rates. Design. Retrospective study of all infants consecutively delivered at 12 facilities. Outcome Measures. Diagnosis of UTI was determined from the KPNC computerized database using the International Classification of Diseases, Ninth Revision code for inpatients and KPNC Outpatient Summary Clinical Record codes for outpatients. A sample of 52 patient charts was reviewed to confirm the International Classification of Diseases, Ninth Revision and KPNC Outpatient Summary Clinical Record codes and provide additional data. Results. Infants <1 year old who were born in 1996 had 446 UTIs (292 in females; 154 in males); 132 (86%) of the UTIs in males occurred in uncircumcised boys. The mean total cost of managing UTI was 2 times as high in males ($1111) as in females ($542). This higher total cost reflected the higher rate of hospital admission in uncircumcised males with UTIs (27.3%) compared with females (7.5%); mean age at hospitalization for UTI was 2.5 months old for uncircumcised boys and 6.5 months old for girls. In 1996, total cost of managing UTI in uncircumcised males ($155 628) was 10 times higher than for circumcised males ($15 466) despite the fact that uncircumcised males made up only 35.1% of the male patient base in 1996, reflecting the more frequent occurrence of UTI in uncircumcised males (132 episodes) than in circumcised males (22 episodes), and the larger number of hospital admissions in uncircumcised males (38) than in circumcised males (4). The incidence of UTI in the first year of life was 1:47 (2.15%) in uncircumcised males, 1:455 (.22%) in circumcised males, and 1:49 (2.05%) in females. The odds ratio of UTI in uncircumcised:circumcised males was 9.1:1. Conclusions. Newborn circumcision results in a 9.1-fold decrease in incidence of UTI during the first year of life as well as markedly lower UTI-related medical costs and rate of hospital admissions. Newborn circumcision during the first year of life is, thus, a valuable preventive health measure, particularly in the first 3 months of life, when uncircumcised males are most likely to be hospitalized with severe UTI.

PMID: 10742321

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Links to further Medical Research Papers (some off-site)


  1. Wijesinha SS, Atkins BL, Dudley NE, Tam PK Does Circumcision Alter The Periurethral Bacterial Flora? Pediatr Surg Int 1998: 13(2-3); 146-148

  2. Serour F, Samra Z, Kushel Z, Gorenstein A, Dan M Comparative Periurethral Bacteriology Of Uncircumcised And Circumcised Males Genitourin Med 1997: 73(4); 288-290

  3. Craig JC, Knight JF, Sureshkumar P, Mantz E, Roy LP Effect Of Circumcision On Incidence Of Urinary Tract Infection In Preschool Boys J Pediatr 1996: 128(1); 23-27

  4. Spach DH, Stapleton AE, Stamm WE Lack Of Circumcision Increases The Risk Of Urinary Tract Infection In Young Men JAMA 1992: 267(5): 679-81

  5. Krieger JN, Ross SO, Simonsen JM Urinary Tract Infections In Healthy University Men J Urol 1993: 149(5); 1046-1048

  6. Wiswell TE, Hachey WE Urinary Tract Infections And The Uncircumcised State: An Update Clin Pediatr (Phila) 1993: 32(3); 130-134

  7. Matsuoka H, Kajiwara I, Tahara H, Oshima K Phimosis As A Pathogenetic Factor In Urinary Tract Infection And Vesicoureteral Reflux Nippon Hinyokika Gakkai Zasshi 1994: 85(6); 953-957

  8. Rushton HG, Majd M Pyelonephritis In Male Infants: How Important Is The Foreskin? J Urol 1992: 148(2 Pt 2); 733-736

  9. Herzog LW Urinary Tract Infection and Circumcision. A Case -Control Study Am J Dis Child 1989: 143(3); 348-50

  10. Wiswell TE, Miller GM, Gelston HM Jr, Jones SK, Clemmings AF Effect Of Circumcision Status On Periurethral Bacterial Flora During The First Year Of Life J Pediatr 1988: 113(3); 442-6

  11. Fussell EN, Kaack MB, Cherry R, Roberts JA Adherence Of Bacteria To Human Foreskins J Urol1988: 140(5); 997-1001

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