Originally Posted by mama24-7
Would you please tell us the basis for this? The only study that I am aware of on UTIs in boys was done on premature boys. Is this a study that was done in a country that does not routinely circumcise? I wonder what the UTI rate of baby boys is in Europe?
Isn't there another step between multiple (which from what you are saying, would be two or more)? My niece had reflux of the bladder & I thought I remembered there being another step. But, I could be remembering wrong.
Out of curiosity, are you a doctor? Did you take the hippocratic oath? Why would you recommend an external body part for an internal problem? What would be your recommendation for a female child who routinely had UTIs? Do you perform circumcisions on consenting individuals? How about non-consenting individuals?
It is nice to have medical professionals here, even if they are not an "inactivist." (Actually, I consider myself a humanist - one who believes in each persons right to their whole body, regardless of any ideas, beliefs, ignorances (is this a word? not sure ), biases, etc. that a parent may have.)
Thanks for answering my questions.
I wish I could do the fancy quote thing!
Here is a meta-analysis (the best possible assimilation of research if done properly). The underlining is mine:
[I'm editing the abstract to quote from the source for copywrite infringement concerns. You can utilize information for purposes of "Research and Study", but it's late and I'm not interested in breaking any laws. :)] ]
Source is from the Arch Dis Child. 2005 Aug;90(8):853-8. [You should be able to look this journal up in a medical or university library.]
Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies.
This is a meta-analysis to analyze the circumcision and the risk of UTI. "Data on 402,908 children were identified from 12 studies (one randomised controlled trial, four cohort studies, and seven case-control studies). Circumcision was associated with a significantly reduced risk of UTI (OR = 0.13; 95% CI, 0.08 to 0.20; p<0.001) with the same odds ratio (0.13) for all three types of study design."
Conclusions: "Circumcision reduces the risk of UTI. Given a risk in normal boys of about 1%, the number-needed-to-treat to prevent one UTI is 111. In boys with recurrent UTI or high grade vesicoureteric reflux, the risk of UTI recurrence is 10% and 30% and the numbers-needed-to-treat are 11 and 4, respectively. Haemorrhage and infection are the commonest complications of circumcision, occurring at rate of about 2%. Assuming equal utility of benefits and harms, net clinical benefit is likely only in boys at high risk of UTI."
One hundred and eleven circs to prevent one UTI. That's why I don't recommend it or push it. The fact is that it is an American "aesthetic". Outside of the United States, the vast majority of circumcisions are done for religious reasons. We are the only ones that do it because many Americans think it "looks good" or "because their fathers were", etc.
Reflux really requires looking at the entire clinical picture. Little girls have a lot of reasons for UTIs, and while reflux is one of them, it is not the most common. I would work on toileting, making sure they are not constipated, etc. before pursuing a VCUG. You can get an ultrasound that may or may not show dilation in the renal collecting system (hydronephrosis), but that has never been shown to correlate to the degree of reflux. Another alternative is to get a nuclear medicine study, but that requires an IV. The AAP guidelines regarding reflux are new and part of the intention is to prevent reflex ordering of the VCUG after a febrile UTI.
Yes I am and yes I did. In fact I have the job that is mentioned in the Hippocratic oath. :) I tell you when I do recommend circumcision, is when I see a male infant with posterior urethral valves. It is rare, but anything that can hurt kidneys that may already be frail can be potentially devastating. (A baby on dialysis is a terrible sight.) That being said, I'm also willing to closely follow a family through the first couple of years if they don't want one.
Information is power, I've always felt that it is up to the patient to determine what is best for them and it is my job to provide information that can be understood and processed. (I'm the queen of analogies.) But taking care of kids is tough. Surrogate decision making that parents make for their children is a controversial and much debated topic in medicine (and, believe it or not, part of the political platforms). Which is why the concept of assent is also very, very important.
And my full disclosure is that I can't be a complete "intactivist" because I have circumcised plenty of men who have asked for it for religious and personal reasons - from teenagers to 70 year old men (because they think it will be the next best thing since sliced bread, their words, not mine!) as well as (and I know that this will make some of you angry, which is not my intent) infants for whom parents have requested it.
A part of my job is trying to teach people (including medical-types) not to fear the foreskin!! (This is especially problematic in nursing homes.)
Edited by Espion - 10/6/12 at 9:03pm