Circumcision prevents urinary tract infection

NEW YORK (Reuters Health) – The results of a new report
confirm that circumcision reduces the risk of urinary tract
infection — but the authors estimate that more than 100 boys
need to be circumcised to prevent one infection.

The authors recommend circumcision only for boys at high
risk of urinary tract infection, but this view is not
universally held, commentators suggest.

A reduced rate of urinary tract infection is the most
frequently cited benefit of circumcision, Dr. Jonathan Craig
and his team at the Children’s Hospital at Westmead in Sydney,
Australia, note in their report, published in the Archives of
Disease in Childhood.

To further investigate, they searched databases to identify
studies published between 1987 and 2001 that reported on
circumcision and urinary tract outcomes. Their review included
12 articles documenting outcomes for approximately 403,000
children and 1953 episodes of urinary tract infection. Maximum
follow-up was 3 years.

Circumcision was associated with a significantly reduced
risk of urinary tract infection, a “substantial reduction,” the
authors note. They calculate that “the number-needed-to-treat
to prevent one urinary tract infection is 111″ in normal boys.
Also, they add, circumcision is associated with a 2 percent to
10 percent complication rate.

Craig and colleagues estimate that the risk of urinary
tract infection is 1 percent in normal boys, 10 percent in boys
with a history of urinary tract infection, and 30 percent in
boys with high-grade reflux of the bladder and ureter.

They recommend that circumcision be considered for boys
with a history of urinary tract infection or high-grade bladder
and ureter reflux, because the “benefit outweighs the risk of
complications in these cases.”

Reflecting a “North American view,” Dr. Edgar J. Schoen,
from Kaiser Permanente Medical Center in Oakland, California,
suggests in a related commentary that the researchers’
interpretation of their findings is flawed.

For example, he notes, circumcision is ideally performed in
newborns, where the complication rate is approximately 0.2
percent to 0.6 percent. He also advocates its use because of
other health benefits, such as prevention of penile cancer,
some sexually transmitted diseases and HIV.

But in a second commentary giving a “European view,” Dr.
Padraig S. J. Malone, from Southampton University Hospitals NHS
Trust in the UK, remarks that “it is doubtful that a
cost-benefit analysis could ever justify routine circumcision”
to prevent urinary tract infections. He does, however,
recommend further studies to examine the benefit of routine
circumcision in preventing kidney scarring.

SOURCE: Archives of Disease in Childhood, August 2005.