Infections of the urinary tract (UTI) are regarded as being COMMON in the pediatric population [192]. The highest prevalence and greatest severity of UTIs in boys is prior to 6 months of age [316, 392], decreasing after infancy [408]. The younger the infant, the more likely and severe will be the UTI and the greater the risk of sepsis and death [314]. A preliminary study in Sweden has shown that early breastfeeding might also lower UTI [219], but, whilst worthwhile for many reasons, is less effective, and cannot be advocated as a replacement for circumcision. Research showing an association of UTI with lack of circumcision is extensive and the link is now unequivocal. Most of the evidence has emerged over the past 20 years or so.
A large study in Canada of equal numbers of neonatally circumcised and uncircumcised boys saw rates of UTI and hospital admissions for UTI that were 4-fold higher in the uncircumcised [356]. In Australia, a relatively small study in Sydney involving boys under 5 years of age (mean 6 months) found that 6% of uncircumcised boys got a UTI, compared with 1% of circumcised [78]. A US study of 1025 febrile infants aged less than 2 months found the cause was UTI in 21.3% in uncircumcised boys, 2.3% in circumcised, and 5% in girls [409]. Odds ratio of UTI associated with being uncircumcised was 10.4 (bias-corrected 95% CI: 4.7-31.4).
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