increased risk of UTIs with intact penis?

[heartandhands]

We have an intact baby boy. He has a congenital problem requiring catheterization from time to time (a few times per year). The nurse fully retracted his foreskin and I almost lost it. She must have reported to her superiors bc I was later visited by the nurse practitioner and head paediatric urologist who both assured me there is absolutely nothing wrong with retracting the foreskin. What am I supposed to say to this? This is the accepted procedure at the leading sick kids hospital in Canada. I know he needs to have this procedure done again at this hospital. Other hospitals employ this same team of docs trained to think this is no big deal so its not like we can take our child elsewhere. Is there a link to info I can print on the proper management of an intact penis? How do I make them listen to me?

The other thing they kept saying was that he will have an increased risk of UTI (and he has already had one and been hospitalized for it due to this congenital problem) bc he is not circ'd and that I should clean it. i have been doing absolutely nothing with it and when giving him a bath, which we dont do often, i just glean over it the same way i would his other parts, gently with a cloth. Is there some recent medical literature supporting their claims of increased risk of UTI? THey kept saying it was recently discovered.

I really do not want to circumcize him but if i am going to have to choose btw watching his foreskin get retracted several times this year and just getting rid of it, maybe i should consider it? I know i have to advocate for my child and i threw up a big fight and said the AAP even recommends not retracting and it was all completely dismissed as nonsense. We absolutely can not forego these tests and procedures bc he may need surgery if it doesnt resolve. So, basically.....help?

[MommytoB]

Why does your son need continous catheritization as in what kind of congential problem does he have is it with his kidneys ?

Also, retraction is BAD and you should find someone who will not do that search around since you said your in Canada right you should be able to find a doctor who knows right things because you do not need to Retract to get a Catheter in.

Also, UTI thing is a bunch of myths the increased risk of UTI in intact males was a flawed study done by wiswell on unequal counterparts .

[emnic77]

There is nothing that shows an increased UTIs in intact boys except for one deeply flawed study. Anecdotally, my intact 5 year old has never had one, ever (or any other problem with his penis) and he's got a friend who's 5 who's been battle UTIs her entire life. No one suggests cutting anything off her, though.

I know I've seen here before from nurses that you absolutely can cath an intact child without retraction. Hopefully one of them will chime in with that info soon! It's really disappointing that with Canada's overall view of circ that you are getting all this bad info and treatment from leading hospitals.

And yes, you are cleaning it correctly. Wipe it off like a finger. The tip is a sphincter, designed to keep things out. Easy peasy. Again, with my 5 year old, this is how we've always done it and how he does it now, and now that I have another baby girl I'm reminded of how it's SO MUCH EASIER to clean an intact baby boy than it is to clean a baby girl!!

[mama2soren]

Well, DS is intact and he had one UTI shortly after his birth. Whether or not his foreskin "caused" his UTI is irrelevant, because after a quick round of antibiotics, it was cleared up. He's never had another one since. The "risk" of having to take antibiotics for a UTI is no argument for cutting off a healthy foreskin, even if the study that showed the link between intact boys and frequency of UTI's wasn't completely flawed (like it was).

You are right, no one should be retracting your son's foreskin! That will put him at higher risk for infection, pain, and scarring! A skilled nurse or doc should be able to cath an intact baby. I'm sorry you have to fight so hard for proper care of your son

[MCatLvrMom2A&X]

UTI and intact are not related in any way. Like pp said that study was deeply flawed and there are no recent studies I am aware of on the subject.

Your word is law here if you say not to do it then they should not do it. I would even go so far is to tell them if they do you will file charges of assault. There is no excuse for them hurting your ds like that and setting him up for possible infection or scar tissue down the road that would require surgical help for him to retract properly when the time is right. Tell them no they cannot retract then stand there where you can reach them and if they try stop them physically if you have to.

The most they should do is gently flair the tip of the foreskin enough so they can see the urinary opening in the glans then insert the cath.

[CallMeMommy]

Originally Posted by MCatLvrMom2A&X

Your word is law here if you say not to do it then they should not do it. I would even go so far is to tell them if they do you will file charges of assault.

This is my thinking, also. Doesn't matter if their policy is to retract - you're the parent and you have every right not to consent to it.

[heartandhands]

THank you for all of your support and suggestions.

Well, I agree that it is abuse but I feel I can hardly scream abuse and then ask them to do the surgery on my son (which he quite possibly will need). I feel I have to maintain some kind of healthy rapport with this team of medical professionals.

Trust me, I am a huge advocate for my children! We do not vax and we cosleep, practice AP, and others things that have fallen out of favour (or were never in favour) with traditional medicine. But this, I feel a bit at their mercy bc I have no where else to turn for his care. As i said, this is the leading children's hospital in Canada.

I need some links to research, if possible, re catheterization of intact penis without retraction bc I told them it was possible and they swear it isnt. They say it contaminates the sample. They see the intact penis as a festering wound apparently? It's so odd. Even when they were talking to me about cleaning it, they recommended paritally retracting it. THey said, you'd never consider not cleaning your baby girl would you? well, its the same thing with an intact baby boy! I completely disagree.

Does anyone have any literature or links they can point me to, that I can take with me to our next appt? I would really appreciate it.

Also, what were the flaws, specifically, with that study which did find an increased risk of UTIs in intact boys? They are all quoting this study like the gospel over at this hospital.

Thanks so much in advance.

[mama2soren]

I don't have much time to respond just now, but it IS TOTALLY POSSIBLE to get a great cath without retraction. I am a nurse. I have done it. It takes practice at first to understand how to do it well, but it's hardly rocket science.

http://www.infocirc.org/uti2.htm (A good article about UTI's and circ)

http://www.cirp.org/library/normal/aap1999/ Strait from the "gods" themselves (the AAP ) on how to care for an intact penis. Even they know not to forcibly retract!

http://www.doctorsopposingcircumcisi...etraction.html
More on forced retraction.

Note that "forced retraction" does not mean that the "caregiver" was extra rough. It means any retraction that the penis owner does not do himself. It is never ok for ANYONE to be fiddling with a child's foreskin. Ever.

[mama2soren]

In case you don't make it all the way through the Doctors Opposing Circ article I posted the link to, here's a bit from the end that you might find useful. If this inappropriate care of your son's penis continues (happens even one more time), I'd encourage you to report it to the hospital and to DOC, who will be in contact with the doctors/hospital. I know you don't want to make a big stink, since you are dependent on the doctors' care for your son. But repeated forced retraction will cause lifelong problems. It must be stopped.


"The best method, of course, is to forbid forced retraction before it occurs, by making your wishes known in advance in no uncertain terms, in writing, with a copy of the AAP guidelines (or maybe this essay) in your hand and made a formal part of your child’s chart. Better to momentarily irritate –or educate– your family physician or nurse than to injure your son for life. D.O.C. has diaper (nappie) stickers we urge parents to use. They say “I’m Intact; Don’t Retract!” This prompts a non-threatening discussion with the Anglophone medical professional.

But if you are ignored and your child is forcibly retracted despite your warning, –it can happen in seconds– you should report the offending rogue physician or nurse to your state medical society, supplying all the details. Or contact our physicians’ group to help you. There is no charge for our intercession though donations are appreciated.

Remember—you have no duty to massage the ego of a poorly-educated medical ‘expert.’
Protect your child instead!

John V. Geisheker, J.D., LL.M.
Executive Director, General Counsel,

On behalf, and at the instructions of,

Dr. George C. Denniston, M.D., M.P.H., President
Doctors Opposing Circumcision
2132 Westlake Ave. N. Suite #150
Seattle, WA 98109
tel [phone]

[heartandhands]

Thank you mams2soren. This is exactly what I need. I appreciate the links so much. I have already told them about the position of the AAP! You would think that made a difference to them but it didnt. We are in Canada and they said they do things differently here. How can it be okay in one geographical area and not another? It's absolutely maddening.

I am still shaking from the foreceful retraction that I saw the nurse do. I told her it wasnt safe and to stop and she just looked at me like i had 3 heads. She said it had to be sterilized. I wanted to throw up and I had to leave the room. It happened to fast, I wasnt prepared for the fact that she would ever have to retract it. i blame myself bc i should have anticipated somethign like that with catheterization. I blame myself. I just pray that my DS is okay and has no scarring. How would I know if damage occurred? The powers that be at the hospital assured me that nothing can happen. How can they say that in light of the literature and information out there. They just kept saying be careful what I believe on the internet. THe more i read here, the more furious I get.

Thanks again.

[jenP]

HeartandHands, I just wanted to offer hugs and support. What a tough time to be going through. I wish you luck with educating this team, hopefully DOC can help, or perhaps finding a different team. Whatever works to get your son proper care.
I wanted to address that study on UTI's. I think someone already posted a link to the DOC website which points out the flaws in the study. I wanted to add that, this badly flawed study is the best that the pro-circ people can come up with in regard to UTI, and even so it only shows a difference for the first one year of life! My son had a UTI at about 10 months of age and the doctor said it was "caused" by his foreskin and that we should circumcise him. How much sense would that make, to have risky surgery like that, for the tiny amount of "lesser" risk of UTI for a lousy two months??? I don't know how old your son is, but the closer he is to one year, the more preposterous it is to suggest circumcision to prevent UTI, when even the most flawed, slanted, biased, pro-circ study admits that after one year the risk is the same.
AND I am not aware of any studies that compared circumcised and intact boys who have underlying congenital problems. It could very well be that the additional "risk" from having a foreskin is negligible for boys who already have dramatically increased risk due to congenital problems. If they are seriously suggesting circumcision, ask them to show you the studies comparing circumcised and intact boys who have the same condition as your son so you can decide for yourself if there is strong enough evidence for enough of a benefit to outweigh the risks and lifelong harms of circumcision.
I wish you all the best.

Jen

[ThatLinGirl]

Wanted to bump this thread to see if anyone has any thoughts on this new study. I'll be interested to see some better peer review but I want to have a response..

http://www.ncbi.nlm.nih.gov/pubmed/20728178

[Fellow Traveler]

Originally Posted by ThatLinGirl

Wanted to bump this thread to see if anyone has any thoughts on this new study. I'll be interested to see some better peer review but I want to have a response..

http://www.ncbi.nlm.nih.gov/pubmed/20728178

Well, the appropriate response would be that this group of boys (those studied) had high grade primary vesicoureteral reflux, a congenital anomaly of the urinary tract. It changes the calculus quite a bit to be honest. In a healthy boy though (one with out high grade reflux) the number of circumcisions one would need to perform to avoid one mild UTI is well over 100.

One thing I did notice though their objective was:

We evaluated the incidence of new permanent defects in boys with grade 4 or 5 vesicoureteral reflux, identified the risk factors [plural] for new permanent defects and reviewed the outcome of different management approaches [plural] by assessing the rates of urinary tract infection and new permanent defects.

Yet the conclusion only discusses a single risk factor and a single management approach.