recurrent infections in my intact boy

[AustinAmber]

I'm posting here because I've never seen so many people who know so much about the intact penis in one place and I'm hoping I can get some good advice and some good links.

Here is my dilemma, DS is 2 years, 9 mos. and intact. In November he was diagnosed with balanitis when I took him to the ped for a red and swollen penis with yellowish discharge. He took a course of antibiotics and it cleared up easily. Now he is diagnosed with a UTI. I took him to a urologist and we have an appt. in a few weeks for a kidney u/s and VCUG to check for urinary reflux. The concern is that he's had two infections recently and there may be an underlying cause. The urologist has already mentioned that circ should be done if there is reflux. The concern is that he may be one of those kids that is genetically predisposed to getting these infections. With recurrent infections he could develop scar tissue that may prevent his foreskin from detatching properly.

I want to be armed with as much information as I can before going on with any of this so I can make the best decision for my son.
I don't want to circ him unless it really is in his best interest. When it comes to the circ issue my motto is "if it aint broke, don't fix it", but maybe it's broke?

[MyBoysBlue]

Here is some reading that might explain why "It still aint broke."

http://www.cirp.org/library/disease/UTI/
http://www.circumstitions.com/Utis.html
http://www.infocirc.org/uti2.htm

[MCatLvrMom2A&X]

Urinary Reflux is NOT a cause to circ. As a matter of fact having the foreskin will help prevent infections not cause them.

How have you been caring for his penis? Do you ever retract or has a Dr. ever retracted him? Retraction is any movement back toward the body not just all the way back but even a tiny bit.

This thread has some information you may find helpful http://www.mothering.com/discussions...d.php?t=764732 The first time might not have even been infection but normal seperation issues.

The UTI had nothing to do with his foreskin at all. The studies that show that where debunked long ago. So the Dr. isnt up to date on current intact care.

During the VCUG do not let them retract your ds if they dont know how to do it without retracting make them bring in someone who knows what they are doing.

[MyBoysBlue]

Ditto on the first infection being separtion issues. My son had the same thing a few months back swelling and yellowy discharge. We just gave him baths with baking soda and it was gone in two days, no abx necessary.

[Anastasiya]

I agree that the first case may very well have been separation trauma, and it may have appeared that the antibiotics cleared it up but in reality it cleared itself up.

Did they even culture anything or just assume?

Granted, I can't be 100% sure, but I would assume that unless he was also running a fever and all that....

As for the UTI, it's his FIRST one. Why a VCUG so soon?

I'd totally cancel the appointment. If he really has a UTI, antibiotics will clear it up just like it clears up UTIs in girls. Nothing more invasive needed right now....I mean, it's ONE UTI, you know? And no, foreskin does not increase UTIs.

If you're retracting him to clean, stop. And don't let doctors do it either.
And don't use soap on his genitals....just swishing in the tub is enough.

[eepster]

This is not a case of recurrent infections, but a case of two mostly unrelated issue that happen to have something to do with the same region and system of the body. The tip of the penis is not the same thing as inside the bladder, even though they are connected by the urethra.

I would be very doubtful of the first DX of balanitis. The symptoms you describe just sound like normal separation of a bit of diaper rash. Was a culture taken?

How was the UTI DXed? What were the symptoms that prompted testing for UTI? Is there a obvious outside cause that would explain the UTI, refusal to drink water, 5 bubble baths a day, refusing diaper changes for extended periods, someone has been retracting him and wiping. I would consider these factors before agreeing to the VCUG.

Considering the Dr is mentioning circ already without even seeing your DS, shows a pretty high level of bias towards the surgery.

There is an advantage to leaving a boy with reflux intact. The recurrent UTIs that may occur are more likely to be symptomatic and therefore DXed. Circumcised boys UTIs are often missed, and therefore not treated.

From the Canadian Pediatric society's website on circumcision

n a retrospective case-control study, 26 men with symptomatic UTI confirmed by microbiological analysis were compared with 52 men who had urinary symptoms but negative results of cultures from urine specimens.52 The groups were similar with respect to age, race and sexual activity. Of the men with a UTI, 31% (8/26) were uncircumcised, whereas 12% (6/52) of the men without a UTI were uncircumcised (p = 0.037, OR 5.6, 95% CI 1.6 to 19.4).

36 in 8 of the 31 patients who underwent radiographic investigation, abnormalities were found. Four of the patients had grade II reflux, two had grade IV reflux, one had posterior urethral valves with hydronephrosis, and one had ureteropelvic junction obstruction with hydronephrosis. Amir, Varsano and Mimouni53 found anomalies of the urinary tracts of three out of eight patients who had a UTI after ritual circumcision. It has been suggested that not circumcising male infants is, therefore, advantageous because it allows early identification of infants who have structural abnormalities that require surgical intervention or close medical follow-up.54,55 Whether the reflux found in the patients in the case-control study was acquired or was a result of a congenital lesion, as suggested by Rockney and Caldamone,54 is unknown.

(bold mine)

ETA: Also read this article.

[AustinAmber]

Thanks for all the info so far, I'm lookiing into everything. I haven't visited all the links yet. I'm not sure how to multiple quote so here are some clarifications.

As far as caring for his penis I wipe it like a finger if dirty and he gets a regular bath, no bubbles and we use senseitive soap like california baby.

When he was an infant the ped retracted him slightly a couple of times until I told him not to, then he stopped. I always remind him at visits that we don't retract.

There was a culture done for the balanitis that was abnormal. Bacteria was present.

The urinalysis was also positive for e. coli. He had painful urination. This is how the UTI was diagnosed.

He was seen personally by the urologist. He has even seen the same uroligist before for a hydrocele surgery. That brings up another concern of mine. Since the hydrocele is a genital abnormality maybe he could have others.

The doc said that if I didn't want to do a circ and he does have reflux then DS should be on preventive abx until the reflux goes away to prevent any bacteria that does get in there from possibly traveling up to the kidneys and doing permanent damage. Of course we don't even know if he has reflux or not.

If the first issue is normal separation trauma, is it normal to have bacteria present in the discharge? It seems like maybe these are two genuine infections which is really concerning. I am really scared about the VCUG, I agree, if it is just a one time thing that it is unnecessary, but with two real infections happening? I don't know. I just want to know all I can.

I'm going to check out some of the links now, thanks again.

[tutucrazy]

Originally Posted by AustinAmber

There was a culture done for the balanitis that was abnormal. Bacteria was present.

Bacteria is always present they would need to tell if there was an overgrowth. We all have good and bad bacteria present in our genitals. It is only a problem if the bad out numbers the good.

The urinalysis was also positive for e. coli. He had painful urination. This is how the UTI was diagnosed.

How did they do the urine catch? Repeat catheter causes UTI!

The doc said that if I didn't want to do a circ and he does have reflux then DS should be on preventive abx until the reflux goes away to prevent any bacteria that does get in there from possibly traveling up to the kidneys and doing permanent damage. Of course we don't even know if he has reflux or not.

Reflux is caused by a structural abnormality of the urinary tract where the kidneys empty. This has NOTHING to do with foreskin or even the penis for that matter. If he has reflux the general treatment is abx, this is no different from a boy with or a without a foreskin. I have a friend who had a son with reflux and he never had another UTI after they found out he had the reflux. She was also pressed to circumcise and did not. She just treated the reflux like you would any other boy or girl.

If the first issue is normal separation trauma, is it normal to have bacteria present in the discharge? It seems like maybe these are two genuine infections which is really concerning. I am really scared about the VCUG, I agree, if it is just a one time thing that it is unnecessary, but with two real infections happening? I don't know. I just want to know all I can.

Yes bacteria is always present but the bacteria that causes UTI (e-coli) is not the same bacteria that caused the foreskin infection. Personally I would not get a VCUG unless he has had more than one UTI. A UTI is an entirely different infection from a mild foreskin infection. One has nothing to do with another. A UTI caused by kidney reflux would be recurrent regardless of his foreskin status so you would know right away if he had reflux if he got another UTI in the near future. Remember, painful urination can also be a symptom of separation, especially if he was manipulated by a doctor as you said he was.

Read here to learn how the foreskin protects against UTI:
http://www.nocirc.org/statements/breastfeeding.php

[eepster]

Originally Posted by AustinAmber

He has even seen the same uroligist before for a hydrocele surgery.

Did this surgery take place shortly before the first infection? Was he catheterized for the surgery?

It is possibly that the bacteria was introduced then. I would suspect this if it is the same strain of bacteria that caused the UTI. Hospitals are teaming with bacteria often bacteria that is very resistant to antibiotics (so even though the first infection was treated, the bacteria might not have been wiped out.)

If the first issue is normal separation trauma, is it normal to have bacteria present in the discharge?

Bacteria is present all over the body. It's a question of what kind of bacteria, how much of it there is. False positives are a possibility in all kinds of tests. This is why it is necessary to clean the penis throughly before putting on a baggy to catch the urine when testing for a UTI.