Does circumcision prevent UTIs in male infants?

Last updated on 7th October 2008

Wiswell set the ball rolling with a "methodologically flawed" study in which he looked retrospectively at the notes of boys born in US military hospitals.[1] Prevention of UTI would not in any case justify the circumcision of infants.[2-3]

The biggest study of the relationship between male circumcision and UTIS BY Theresa To and colleagues.[4] The study concluded - based on a study of 60,000 boys - that you would need to do 195 circumcisions to prevent one UTI requiring hospital admission. This study did not control for discharge diagnosis. If just 0.5% of the intact boys in here study were admitted to hospital for circumcision since "these uncircumcised boys will always have lots of UTIs", it would wipe out the "protective" effect of circumcision. If >>0.5% of intact boys were referred to hospital for circumcision then the effect would work in the opposite direction.

One study of 47 febrile infants in which 17% had UTI (suprapubic aspiration). All infants with UTI were male and UTI occurred a few days after Jewish ritual circumcision. The authors concluded that circumcision itself may cause urinary retention and UTI.[5] The results support the conclusions of an earlier study by the same lead author.[6]

Goldman and colleagues noted UTIs following Jewish ritual circumcision and concluded that there may be a causal relationship between UTI and circumcision.[7]

Cohen and colleagues studied the epidemiology of UTI during the 1st year of life in 169 children concluded that Ritual Jewish circumcision as practised in Israel may be a predisposing factor for UTI during the 12-day period following that procedure.[8]

Confirmation that circumcision prevented urinary tract infections would require a randomised controlled trial. One such trial has been published and concluded that circumcision was not effective in preventing UTIs.[9]

1.Wiswell TE, Smith FR, Bass JW. Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics. 1985; 75:901-3.

2.Amato D, Garduno-Espnosa J. Circumcision of the newborn male and the risk of urinary tract infection during the first year: a meta-analysis. Bol Med Infant Mex. 1992; 49(10):652-658.

3.Van Howe RS, Cold C. Circumcision of newborn boys (letter). The Lancet. 1999; 353:670.

4.To T, Agha M, Dick PT, Feldman W. Cohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection. The Lancet. 1998; 352:1813-20.

5.Amir J, Varsano I, Mimouni M. Circumcision and urinary tract infections in infants (letter). Am J Dis Child. 1986; 140:1092.

6.Amir J, Alpert G, Reisner SH, Nitzan M. Fever in the first year of life. Isr J Med Sci. 1984; 20:447-8.

7.Goldman M, Barr J, Bistritzer T, and Aladjem M. Urinary tract infection following ritual Jewish circumcision. Isr J Med Sci. 1996; 32:1098-1102.

8.Cohen HA, Drucker M, Vainer S et al. Postcircumcision urinary tract infection. Clin Pediatr (Phila). 1992; 31(6):322-4.

9.Kwak C, Oh SJ, Lee A, Choi H. Effect of circumcision on urinary tract infection after successful antireflux surgery. BJU Int. 2004; 94(4):627-9.