Just stashing these here.
Prevention of UTI
Chessare116 developed a model for decisions concerning circumcision of newborn male infants to prevent UTIs. In the model, the probability of having a UTI in the first year of life was considered to be 4.1% for an uncircumcised boy and 0.2% for a circumcised boy,33 and the likelihood of renal scarring as a result of a UTI was considered to be 7.5%.47 The probability of minor complications was set at 21.8%, which is a much higher incidence rate than the rate of 0.19% reported by Wiswell and Geschke91 or of 2% to 10% estimated by the authors of a recent review.90Chessare stated that the rate of minor complications has no effect on the preferred choice. Major complications were not included because they are relatively rare. All possible outcomes were ranked from worst (e.g., circumcision followed by renal disease) to best (e.g., no circumcision and no later UTI) on a scale of 0 to 1. For the set of values assigned to the possible outcomes, the highest expected benefit was obtained from the choice not to circumcise. The choice would remain not to circumcise even if none of the infants circumcised had complications as a result of the procedure and would change only if the probability of a UTI in the first year of life was 29% or greater. The possible reductions in the risk of penile carcinoma and of HIV infection were not considered in this model.
Thompson21 interpreted the published data by considering a hypothetical cohort of 2000 newborn male infants, half of whom were circumcised and half of whom were not. Given an incidence of UTI of 0.1% in the circumcised boys and of 1.0% in the uncircumcised ones during the first year of life, he calculated that there would be nine more UTIs for every 1000 newborns who were not circumcised. Thus, 99.9% of the circumcised infants would not experience a UTI, whereas 99.0% of the uncircumcised group would not have a UTI. Given a complication rate of 0.2%,91 Thompson estimated that, whereas 9 boys out of 1000 circumcised would benefit from circumcision, 12 would have moderately severe complications. At a complication rate of 4.0%, 41 boys would have moderately severe or worse complications. He concluded that the potential benefit to 9 in 1000 boys would be more than offset by the rate of moderately severe or worse complications, even if this rate was as low as 0.2%.
In 1982 it was reported that 95% of UTIs in boys aged 5 days to 8 months were in uncircumcised infants [Ginsburg & McCracken, 1982]. This was confirmed by Wiswell in 1982 and a few years later Wiswell and colleagues found that in 5261 infants born at one US Army hospital, 4% of UTI cases were in uncircumcised males, but was only 0.2% in those who were circumcised [Wiswell et al., 1985]. This relatively captive population in Hawaii was said to be more reliable than the rate reported for hospital admissions [Wiswell, 2000].
Wiswell then went on to examine the records for 427,698 infants (219,755 boys) born in US Armed Forces hospitals from 1975-79 and found that the uncircumcised had an 11-fold higher incidence of UTIs [Wiswell & Geschke, 1989]. During this decade the frequency of circumcision in the USA decreased from 84% to 74% and this decrease was associated with an increase in rate of UTI [Wiswell et al., 1987]. Reviews by others in the mid-80s concluded there was a lower incidence in circumcised boys [Roberts, 1986; Lohr, 1989].
The rate in girls was stable during the period it was increasing in boys, in whom circumcision was in a decline. In a 1993 study by Wiswell of 209,399 infants born between 1985 and 1990 in US Army hospitals worldwide, 1046 (496 boys) got UTI in their first year of life [Wiswell & Hachey, 1993]. The number was equal for boys and girls, but was 10 times higher for uncircumcised boys. Among the uncircumcised boys younger than 3 months, 23% had bacteremia, caused by the same organism responsible for the UTI.
Premature uncircumcised boys had an 11-fold increase in risk of UTI and circumcision eliminated the risk of recurrence of UTI in a study in Augusta, Georgia [Cason et al., 2000].
Wiswell performed a meta-analysis of all 9 studies that had been published up until 1992 and found that every one had observed an increase in UTI in the uncircumcised [Wiswell & Hachey, 1993]. The average was 12-fold higher and the range was 5- to 89-fold, with 95% confidence intervals of 11-14 [Wiswell & Hachey, 1993]. Meta-analyses by others have reached similar conclusions.
Let me conclude this post, which serves only to provide me a place to find this info again, by noting that a UTI could literally kill my son.
(there’s more, too)