Quote:
Originally Posted by shllywlly  ...I did speak to our normal ped who is very intact friendly. He doesn't believe it has anything to do with his retractability like the urologist thinks, but he did understand that not being retractable could post an increased risk to someone who was already prone to uti's. If my son is predisposed to uti's and there is urine that is left sitting in the foreskin, then he feels it could increase the risk of it turning into an infection.
He said he would not normally advocate worrying about the retractability, but he said in my son's case, it might not hurt to gently encourage the process. He suggested talking to my son about it and encouraging him to pull the foreskin back slightly when he is peeing to prevent urine from accumulating under the skin. He also suggested such things and vit e. ointment once a day to loosen things up. He didn't suggest forcing the skin to retract only encouraging it to move along...
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I do not think this is accurate. I would really get a second opinion on this, he may be supportive, but he does not sound like he has all the facts. Here are some excerpts from
http://www.doctorsopposingcircumcision.org that may help.
Regards,
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Urinary Tract Infections
Ginsburg & McCracken (1982), who studied urinary tract infection (UTI) in male infants at Parkland Hospital in Dallas, noted that 95% of the infant male UTI patients were not circumcised.34 They speculated that lack of circumcision may have contributed to the infection in some way. However, Parkland Hospital, a public hospital, did not perform neonatal circumcisions, even if patients demanded it,35 so most of the client population at Parkland must have been noncircumcised—a fact apparently overlooked by Ginsburg & McCracken.
This observation prompted Wiswell et al. to produce retrospective studies regarding UTI in circumcised infant males as compared with uncircumcised males. The studies all have serious methodological flaws, including failure to control for confounding factors, which include maternal infection, perinatal anoxia, high or low birthweight, prematurity of birth, rooming in, method of urine sample collection, type of hygienic care, and breastfeeding. The Fetus and Newborn Committee of the Canadian Paediatric Society (1989) examined data provided by Wiswell et al. and reported that they found Wiswell’s data to be “not sufficiently compelling to justify a change in their existing policy that circumcision is unnecessary and should not be performed."36 Altshul (1990) pointed out that the studies had only shown association, not cause and effect.37 Thompson (1990) found that “unequivocable proof that lack of circumcision is a risk factor for increased urinary tract infection is currently unavailable.”38 Chessare (1993) compared the alleged advantage of preventing UTI with the disadvantages of complications and found that, even if Wiswell was correct in his claims, non-circumcision would still produce the highest medical utility.39
Evidence from Israel establishes a compelling association between ritual circumcision on the eighth day and immediate post-circumcision UTI.40-42
Mueller et al. (1997) reported no difference in the incidence of UTI in circumcised and non-circumcised boys with normal urinary tract anatomy.43
To put this matter into perspective, a Swedish study by Mårild et al. (1998), where infant circumcision is not practiced, found that, in the first six years of life, the incidence of UTI in boys was 1.8 percent, but in girls it was 6.6 percent.44 UTI infection in boys was rare after the first year of life. When UTI does occur, it is easily treated medically. McCracken (1989) and Larcombe (1999) report UTI infections respond rapidly to anti-microbial therapy.,45,46
The Task Force on Circumcision of the American Academy of Pediatrics, in their “evidence-based” statement, reported serious methodological flaws in all existing studies, and declined to recommend circumcision to reduce UTI.22 The Royal Australasian College of Physicians (RACP) says routine non-therapeutic circumcision “cannot be justified on the basis of preventing a UTI.”47
The consensus of medical opinion is that circumcision is of little, if any, value in reducing UTI. Risk, complications, an disadvantages of circumcision outweigh any reduction in UTI. The notion that neonatal male circumcsion can prevent UTI increasingly is being viewed as a medical myth – one started by Ginsburg & McCracken’s failure to recognize that the client population at Parkland Hospital in Dallas was mostly noncircumcised.
Medical authorities now recommend breastfeeding, not circumcision, to reduce UTI in infancy.48,49 Moreover, Hansen (2004),50 and Mårild & others (2004)51 report that breastfeeding continues to have a protective effect even after weaning.
Kwak et al. (2004) report that circumcision after anti-reflux surgery to prevent UTI is not effective. 52
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The great majority of newborn infant boys are born with the inner surface of the prepuce fused with the glans.2 In addition, the tip of the prepuce at birth usually is too narrow to allow retraction. The duration of these conditions vary with the individual but can last until the completion of puberty or longer. For these two reasons, the non-retractile foreskin is normal in childhood and adolescence and cannot be considered a disease requiring treatment.
The first data on development of the retractile prepuce was provided in 1949 by British pediatrician Douglas Gairdner.22 Gairdner said 80 percent of boys have a retractable foreskin by the age of two years, and 90 percent of boys have a retractable prepuce by the age three. His erroneous information23 has been incorporated into medical textbooks and medical school curricula for decades, and it still is repeated in medical literature today.24
Gairdner’s data are inaccurate23-25 and, unfortunately, most healthcare providers have been taught this inaccurate information,24,25 which contributes to improper diagnosis of “pathological phimosis” in the healthy, normal, non-retractile foreskin. Retractability usually occurs much later than previously believed.2,24,25 About 44 percent of boys have a fully retractable prepuce by age 10-112,27,28,29 and about 95 percent have a fully retractable prepuce by age 18.2,27 Non-retractile foreskin is the more common condition until 10-11 years of age. Thorvaldsen & Meyhoff (2005) report that the mean age of first foreskin retraction is 10.4 years.29 Non-retractile foreskin in childhood and adolescence is not a disease and does not require treatment.
Ballooning of the prepuce in childhood during urination is harmless and self-limiting. Babu et al. (2004) have shown that ballooning does not cause obstructed voiding.30 Ballooning disappears with increasing maturity. No treatment is required.31
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"The prepuce, [or] foreskin, is normally not retractile at birth. The ventral surface of the foreskin is naturally fused to the glans of the penis. At age 6 years, 80 percent of boys still do not have a fully retractile foreskin. By age 17 years, however, 97 to 99 percent of uncircumcised males have a fully retractile foreskin. Natural separation between the glans and the ventral surface of the foreskin occurs with the secretion of skin oils and desquamation of epithelial cells, [or] smegma.”
Roberton's Textbook of Neonatology also warns:
“Forcible retraction in infancy tears the tissues of the tip of the foreskin causing scarring, and is the commonest cause of genuine phimosis later in life.”
Avery's Neonatology, issues a further warning :
'Forcible retraction of the foreskin tends to produce tears in the preputial orifice resulting in scarring that may lead to pathologic [i.e., in this case, iatrogenic, or physician-induced] phimosis.”
Similarly, Osborne's Pediatrics notes that phimosis or paraphimosis is “usually secondary to infection or trauma from trying to reduce a tight foreskin…” Moreover, they later state, “circumferential scarring of the foreskin is not a normal condition and will generally not resolve.”
And even the American Academy of Pediatrics, (those who formerly discouraged breastfeeding and encouraged daily forced retraction of intact boys) has now changed its tune:
“...foreskin retraction should NEVER be forced. Until separation occurs, do NOT try to pull the foreskin back - especially an infant's. Forcing the foreskin to retract before it is ready may severely harm the penis and cause pain, bleeding and tears in the skin. " (From the AAP bulletin, "Care of the Uncircumcised Penis").
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And finally this may help:
http://www.doctorsopposingcircumcisi...kinleaflet.pdf
). Try asking your paed what he would do if your DS was a DD - it's amazing how much less they worry about girls when there isn't anything to "do" about it (i.e. cut off).
