Friday, December 04, 1998
New study questions need for circumcision

Anti-infection benefits much lower than once thought

Tom Arnold National Post

The often cited benefit of circumcising newborns to reduce the risk of severe kidney and bladder infections is much lower than previously reported, according to a major Canadian study to be published tomorrow in a leading international medical journal.

The three-year study of more than 58,000 Canadian male infants indicates circumcision in newborn boys does lower the risk of urinary tract infections, but concludes that earlier studies suggesting infection rates are up to 39 times higher for uncircumcised children are vastly overestimated.

"It does lower the risks of urinary tract infection during the first three years of life, but the effect is not as dramatic as other studies have previously suggested," said Dr. Teresa To, a University of Toronto associate professor and lead author of the study. "Other studies have said that uncircumcised boys have a risk of urinary tract infection ranging from about five times to 39 times higher than circumcised boys.

A lower risk of urinary tract infections in the bladder and kidneys is one of the most common reasons to support circumcision of newborns.

"So this is a very important piece of news," added Dr. To of the Hospital for Sick Children's population health sciences research program.

The study concludes that uncircumcised infants have a 3.7 times greater risk of being admitted to hospital with an urinary tract infection than circumcised infants.

Dr. To's research appears in the Dec. 5 edition of The Lancet.

The study also found hospital admissions for urinary tract infections in healthy boys is extremely low, said Dr. To. "Almost nearly 200 boys would have to go through circumcision in order to prevent one admission for urinary tract infection."

The study suggests 195 circumcisions would need to be performed to prevent one hospital admission for urinary tract infection in the first year of life, a rate of less than 1%.

The study included 58,434 males who were born between April 1993 and March 1994. They were followed for three years to determine if they required hospitalization for a urinary tract infection. Some 29,217 babies were circumcised before the age of one month and were each matched to an uncircumcised boy with the same date of birth. During the follow-up period, 83 circumcised boys were admitted, in comparison to 245 uncircumcised infants.

"I'm in agreement with the findings," Dr. Doug McMillan, chairman of the foetus and newborn committee for the Canadian Paediatric Society.

The Canadian Paediatric Society has found the only benefit to circumcision --a procedure that involves cutting away the inner and outer layer of foreskin -- is a reduced risk of urinary tract infection, but it has argued that it afflicts less than 2% of males and can be treated with antibiotics.

"There is no need for a routine circumcision, but we would respect the rights of parents to make an informed decision," added Dr. McMillan, professor of paediatrics at the University of Calgary.

Last year, a study led by Hospital for Sick Children researchers demonstrated that not only do male infants feel pain during circumcision, but they remember that pain six months later when receiving their routine vaccination.

Circumcision remains controversial, but it is still a common procedure. About 30% of male infants in Canada are circumcised annually.

The main reason for circumcision is so newborns will match their father or brothers.

About one in six boys and men in the world has been circumcised, in most cases for religious reasons.

URINARY INFECTIONS

Circumcised (29,217 boys) Uncircumcised (29,217 boys)

Hospital Cumulative Hospital Cumulative infection rate infection rate

Age admissions (per 1,000) admissions (per 1,000)

1 month 10 0.34 45 1.54

2 months 22 0.75 95 3.25

3 months 30 1.08 126 4.31

6 months 42 1.44 172 5.89

9 months 51 1.75 192 6.57

1 year 55 1.88 205 7.02

3 years 84 2.96 247 8.75

The Lancet, Dec. 5, 1998

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