THE CIRCUMCISION REFERENCE LIBRARY
To the Editor.—
Wiswell, Smith, and Bass (Pediatrics 1985;75:901-903) report an association between circumcision and decreased urinary tract infections in infancy. There being no plausible physiologic explanation for such a finding, before we accept any cause and effect relationship and the possible consequence (reversal of the worldwide trend away from routine circumcision of the newborn), we should seek alternative explanations. Several suggest themselves: (1) the two populations, having self-selected themselves (to have or not have circumcision) differed in some way, socioculturally, in their prenatal habits or in their child-rearing behavior and these differences, not the circumcision, resulted in the discrepancy in incidence of urinary tract infection: (2) the advice given to parents, ie, to retract the foreskin lead to trauma and thereby opened a portal of entry for pathogenic bacteria; (3) the catheterization process introduced bacteria into the specimen and perhaps into the bladder.
Drawing conclusions about the relative incidence of disease in nonrandomized populations is a chancy business. Nonetheless, it could be worthwhile to compare epidemiologic data on urinary tract infection incidence in infancy in countries like Denmark, Sweden and the United Kingdom, where less than 1% of male infants are circumcised. Until better data are available, we would be well advised to counsel patients to leave the penis alone both at birth and afterward.Nicolas Cunningham, MD, Dr PH
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