[CIRP Note: Paediatrics and Child Health is the official journal of the Canadian Paediatric Society, Ottawa, ON, Canada.]
A Cohort Study on Male Neonatal Circumcision and the Subsequent Risk of Urinary Tract Infection.
T To, M Agha, PT Dick, W Feldman.
Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Center, and Paediatric Outcomes Research Team, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
Background: A frequently cited rationale for routine circumcision is the reduced risk of developing urinary tract infection (UTI) among circumcised boys. The incidence of UTI has been reported to be 10-20 times higher in uncircumcised boys.
Method: An Ontario newborn males cohort was followed prospectively for up to five years to study circumcision and subsequent risk of hospitalization for UTI. Using hospital discharge data from the Canadian Institute for Health Information, 61,543 boys born from April 1, 1990 to March 31, 1991 were followed for hospitalizations till March 31, 1995.
Results: Among these eligible boys, 39% (23,872) were circumcised and 61% were uncircumcised. The five-year probabilities of hospitalization for UTI were 3.7 per 1,000 (87 cases in the circumcised cohort) and 11.3 per 1,000 (424 cases in the uncircumcised cohort)(p<0.001). The estimated relative risk (RR) indicated that uncircumcised children had a significantly higher risk for UTI hospitalization for UTI (RR-1.1, 95% CI:2.5,3.8). The cumulative risk for UTI hospitalization reaches a peak in the 1st year of life. Six hundred and twenty-five infant boys would need to be circumcised to prevent one UTI hospitalization in the first 5 years of life.
Conclusions: In Ontario, 23,000 infant boys are circumcised annually. Uncertainty about the medical indications and 3-fold risk of hospitalization from UTI supports the notion that neonatal circumcision protects infant boys from UTI, the relative risk is low compared to the relative risks of UTI reported by others. The large numbers of circumcisions needed may be difficult to justify on the basis of UTI prevention.
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