5 mo. old w/recurrent UTIs--uro wants to circ--advice?

[ladylivewire]

Looking for a little advice or stories from parents who have been in my situation. My five-month-old son is intact and has just been diagnosed with his third UTI. He was born at home, full term and has been totally healthy. Exclusively breastfed, normal urine output, no failure to thrive (boy is a 19-pound TANK). He got his first UTI when he was two months old--he had never been retracted. He was hospitalized due to very high fever. At the hospital, he was retracted for catheterization and the nurse told me he was easily retractible and didn't have a tight foreskin. He had a kidney ultrasound and a VCUG and both came back normal.

After the second UTI, our pediatrician sent us to a urologist. They said the only thing they can do is circumcise. The NP there said if we don't circ, he will keep getting UTIs over and over again indefinitely. She said circing has a 70-80% chance of getting rid of the UTIs permanently. I said I wanted to wait and see if he got another UTI before making a decision.

Now that he has his third UTI, our pediatrician wants us to go back to the urologist. I know they are going to push circing again. If this is necessary and it'll help, then we'll do it. But I worry about it not helping. I also worry about the general anesthesia they say he'll need.

Does anyone have experience with this? Do I have other options? Prophylactic antibiotics? My husband is not thrilled about giving abx daily and neither am I ... I'm not sure what the lesser of two evils is here.

Obviously I would prefer not to cut my son, but if he needs it ... I'd like for these UTIs to be done with, for his sake. I am considering getting a second opinion, but I have met with the only pediatric urologist in our town. I am willing to travel to talk to another doctor, but I'm afraid of wasting my time/putting stress on the family just to be told, again, to circ him already.

Thanks in advance, mamas. 

[MCatLvrMom2A&X]

There is no medical evidence that circing will stop his UTI's. If your ds had already been circed and having these UTI's (and yes circed boys get recurrent UTI) what would they do then, they would treat them and try to get to the bottom of the problem.

What happens if he is circed then he gets another UTI, what will they cut off then? Your ds will have undergone a surgery that cannot be undone and you will still be stuck not only with that but dealing with the UTI's. Ask them flat out if they can guarentee that having him circed with cure the problem I bet they will tell you no but it will have a good chance which isnt nearly good enough IMO.

My personal advice is to treat this like it would be treated if it where you dd having the UTI's and contact Maralyn and find a good intact friendly/knowledgeable Dr. and figure out what the real problem is here.

I would contact Marilyn Milos and see if she cant help you find a intact knowledgeable Dr. Here is her contact information.
NOCIRC(Maralyn Milos)
PO Box 2512
San Anselmo
CA 94979-2512
[e-mail]
Phone: [phone]
Fax: [phone]
www.nocirc.org

She is always happy to help out for things like this.

Please contact her and find a Dr. who will help your ds and not alter his body without cause.
Edited by MCatLvrMom2A&X - 5/2/11 at 4:02pm

[Lory]

As far as doctors in your area who won't pressure you to circ, I really like this list:

http://www.thewholenetwork.org/intact-friendly-doctors.html

Concerning your other questions, I'll leave that for everyone else to answer since they probably know a lot more about it than myself. I will say though, that I think it's really odd that after only the second UTI they told you the only solution is circumcision... I have a feeling if you called or e-mailed a European pediatrician about it, since they are used to intact babies over there, you might get advice on other options that don't involve surgery, or insight on the potential causes of the infection. The only thing that caused my childhood UTIs was when I wiped from back to front, which was quickly corrected... so it seems counterproductive to remove the piece of skin that's protecting his penis from the bacteria in the contents of his diaper, since that's the very stuff that gave me UTIs. Just my thoughts, though.

[mama24-7]

not sure if someone mentioned it already, but perhaps you could ask them what they would do w/ a female who gets UTIs - circ her?

sus

[Lula's Mom]

His foreskin definitely doesn't have anything to do with his UTIs!  As a pp, said, circumcised boys can get recurrent UTIs too. 

eta: I missed where you said his tests showed he didn't have kidney reflux.  I would still much rather give my son antibiotics than surgery! 

[MCatLvrMom2A&X]

I totally agree about the meds over surgery.

[vachi73]

(Sorry if this is repetitive.)

Three UTIs in three months, right? Sounds to me like the infection has not totally cleared, and a different (more aggressive and/or more specific) antibiotic might be more appropriate than amputative surgery. Has anyone cultured the infection to see exactly what it is?!

I don't mean to scare you, but there are some infecting organisms out there that are resistant to common antibiotics (e.g. MRSA, one which --sadly -- can be rampant in hospital nurseries/NICUs, etc.) ... given that he was (appropriately) in the hospital at two months, and retracted/cathed there, unfortunately, he may have been exposed to a more virulent (harder to clear/treat) organism than he would normally encounter in the "real" world.

My next step would be to culture his urine for the infecting organism and try to find an antibiotic that will truly clear it ... and I would not subject your son to a cath (or circ for that matter) except in life-threatening circumstances (which, with his high fever at two months, you did already have!) If at all possible, I would request (even be pushy about it) a clean-catch bag for the urine specimen. That may be a real challenge (doctor will want a cathed sample to reduce the odds that a normal skin bacterium gets into the sample), so you'll have to use your best judgment there -- maybe a NICU nurse could do it?

I am so sorry you are going through this. I can tell that you just want what's best for your baby. Trust your mama instincts, and find a doctor who will help you identify and treat the real infection until it is totally cleared. Then, hopefully, you'll never have another UTI ever again!!

Keep us posted, and take care of yourself and your baby!

Edited to add: the research that linked UTI to intact foreskin was done a long time ago, and (apparently) gained substantial traction in the medical community. However, it is my understanding that the study actually compared full-term circ'd boys to preemie intact boys (many of whom may have been cathed at some point during their NICU stays), and that when controlled for this factor, no association was found. Someone else can correct me -- but I think I'm more or less correct. All of which is to say, there is no reason to associate UTI with your son's foreskin. The two are unrelated. Most likely, he was just unlucky in getting the initial infection, and it just hasn't totally cleared yet.

[Cheshire]

I've been in your shoes but our son was a bit older.  He was four years old when he had a string of UTIs.  Each time they did a urinalysis they cultured for the bacteria (always E. coli).  Finally went to a urologist.  He had a line that went something like "even in Europe they circ for recurrent UTIs." I do have to give him credit because he said once you remove it and it doesn't fix the problem you can't put it back on again. He wasn't pushy and I kept saying "circ is not an option for us." 

I had posted on here about it and another poster suggested a longer course of antibiotics and a more targeted one than the ones we had used so far.  So, I suggested it to the doc and he was open to a 20 day course.  After the 20 days we went back and the UTI was gone.  During that time we found out our son was causing the re-infections (he was learning to wipe his bottom and would wipe first then dab at the tip to remove any drips - essentially he was wiping back to front).  When we figured out what he was doing the infections stopped.

Now, obviously your little one isn't causing this himself but neither is his foreskin.  You can take care of this without surgery even if it means a longer term course of antibiotics  You are his best advocate for getting him through this and keeping him intact at the same time.  It can be really hard to look at the "expert" and tell them circ is not going to happen.  It can mean talking to more than one doc (we went to three before it was said and done) to find the right partner to heal your little one.

Best wishes and many hugs!!!

[ladylivewire]

Thank you all for your input. I appreciate all the support so much.

Luckily (I suppose) his doctor just called and it turns out this infections is actually *not* UTI number 3, but balanitis. So he said that if this clears up and he never gets another infection, we won't even discuss circing again.

We did have a test after UTI #2 to make sure the infection was totally gone. My thought was that the 1st one and the 2nd one were the same because my son spits up A TON and probably didn't get all the antibiotics he needed. So after the second UTI, he tested clear (bag urine test--my doctor doesn't cath unless absolutely necessary).

So if this doesn't reoccur, we are in the clear. Now, my question is -- can I keep him cleaner to avoid balanitis? I do not retract him to bathe him, I just let his penis soak in the tub when he bathes. Am I doing enough or is there more I can do to help out?

Thanks so much for your wisdom, mamas! 

[MCatLvrMom2A&X]

Keep in mind to that normal separation can often present in what looks like infection here is a thread that goes into detail about normal separation issues http://www.mothering.com/discussions/showthread.php?t=764732

Discharge, redness and pain can often be associated with the natural separation process and have nothing to do with infection. Usually it clears up on its own within 24-48 hours when it is separation while infection will continue to worsen during and past that time frame.

The only real way to tell the difference if you dont want to take the wait and see approach is a swab of the tip of the foreskin which will show any bacteria that is present.

In the bath if he sits in soapy water make sure to rinse him off really well with clear water before taking him out. Many kids both boys and girls are very sensitive to soap. Overcleaning can be an issue as well so when changing his diaper just wipe off with a baby wipe or a wet wash rag no soap.

When my ds was in diapers I never even touched his penis to wipe it off unless he got poo on it. The only thing I did do on occasion was raise the whole thing up and check for redness between the scrotum and penis because he would get red there on occasion I would put some diaper cream on there if it was looking irritated.

In the bath before he got out I would do a swish in the water then rinse him off before taking him out.

[MCatLvrMom2A&X]

Here are some links about intact and UTI they show no relation between the two.
UTI myth: http://www.cirp.org/library/disease/UTI/
http://www.nocirc.org/statements/breastfeeding.php

In fact, UTI's are so rare in any case that, using Wiswell's data, 50 to 100 healthy boys would have to be circumcised in order to prevent a UTI from developing in only one patient. (Using more recent data from a better-controlled study, the number of unnecessary operations needed to prevent one hospital admission for UTI would jump to 195.

FORESKINS: Seek Elsewhere for Infants' Urinary Tract Infections
http://www.cirp.org/news/1997.12.22_PhysiciansWeekly/



UTI Neonatal circumcision revisited
http://www.cps.ca/english/statements/FN/fn96-01.htm#PREVENTION%20OF%20UTI


The incidence of Geniturinary abnormalities in circumcised and uncircumcised presenting with an initial urinary tract infection by 6 months of age
http://www.cirp.org/library/disease/UTI/mueller/