G e o r g e   H i l l
                        1323 North River Road
                  Port Allen, Louisiana  70767-3303
                     E-mail: DYKS96A@prodigy.com
               Tel: 504-383-8067    Fax: 504-381-8200
                          16 February 1998




Carole Marie Lannon, MD, MPH
Chair, Task Force on Circumcision
c/o Mr. Edward P. Zimmerman, Director
Division of Physician Payment Systems
American Academy of Pediatrics
P. O. Box 927
Elk Grove Village, IL  60009-0927

Re: UTI and Circumcision

Dear Dr. Lannon:

Further research has discovered a new abstract[1] in a supplement of
abstracts published by Paediatrics & Child Health, the official
journal of the Canadian Paediatric Society.

This abstract reports a prospective study on the incidence of UTI in
circumcised and intact male children in Ontario.  This study reports
dramatically different results from those reported by Wiswell's
retrospective studies a decade ago.[2,3]  This report finds 625
circumcisions would be necessary to prevent one case of UTI.

Unfortunately this new study does not indicate any efforts to control
for confounding factors.  In addition, it must be remembered that
Mueller and colleagues found no significant difference in incidence of
UTI in circumcised and intact children.[4]

I am also enclosing the Pisacane study on the value of breastfeeding
in the reduction of the incidence of UTI.[5]

                                     Cordially yours,



                                     George Hill


References

1. To T, Agha M, Dick PT, et al. A cohort study on male
   neonatal circumcision and the subsequent risk of urinary
   tract infection. Paediatr Child Health, Vol 2 Supple A
   May/June 1997:55A

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

3. Wiswell TE, Roscelli JD. Corroborative evidence for
   decreased incidence of urinary tract infections in
   circumcised male infants. Pediatrics 1986; 78:96-9

4. Mueller ER, Steinhardt G, Naseer S. The incidence of
   genitourinary abnormalities in circumcised and
   uncircumcised boys presenting with an initial urinary
   tract infection. Pediatrics 1997;
   100: 580 (supplement)

5. Pisacane A, Graziano L, Mazarella G, et al. Breastfeeding
   and urinary tract infection. J Pediatrics 1992; 120:87-9.