A recent study in Scotland concerns a group of 1000 children aged 0-16 years, consisting of 820 girls and 180 boys, who were referred to a centralized urinary tract infection unit in Western Scotland. UTIs are the only health problem for which there might conceivably be a tiny health benefit from early circumcision, but the study is of interest because it shows that UTIs are far more common in girls than in boys, and that circumcision is rarely necessary to correct cases of recurrent UTIs. The authors note that of the 180 boys referred for a first UTI, only 3 of them (1.7%) subsequently had to be circumcised due to recurrent UTIs. Since circumcision is rare in Scotland and “routine circumcision” practically unknown, it may be assumed that all (or nearly all) the boys were uncircumcised. This is suggested by the fact that the authors make no breakdown of the numbers by foreskin status.

The authors also present age-specific male-female ratios showing that girls are far more subject to UTIs in all age groups, even among children under 6 month of age (where the M:F ratio is 1:2). This is in contrast to some other studies finding that in this age group boys outnumber girls. Given the nature and size of the study (unselected, consecutive material, except for the likely underrepresentation of children with prenatal urinary tract problems identified by ultrasound), the results provide solid evidence that UTIs in early infancy are not a particular male problem that requires particular “male solutions”. The protocol used here seems to catch the vast majority of children in need of intervention, and shows that circumcision has no preventive place in that protocol, except among those very few boys who experience recurrent UTIs. In other words, rather than advocating routine circumcision for the prevention of UTI in boys (which, in any case, occur in only 0.5%-1% of boys), circumcision should be reserved as an option in those very few boys (only 1.7% according to this study) who experience recurrent UTIS. This means that no more than about 0.01%-0.02% (2% of 0.5%-1.0%) of boys should ever need to be circumcised for this reason.

Source: E. Broadis et al. ‘Targeted top down’ approach for the investigation of UTI: A 10-year follow-up study in a cohort of 1000 children. Journal of Pediatric Urology 2015 early view: http://dx.doi.org/10.1016/j.jpurol.2015.07.006