Friday, July 13, 2012

MONTREAL: Study of natural infant phimosis and UTIs spun to promote circumcision

And therefore Carthage must be destroyed

The Canadian Press
July 10, 2012

Doctor urges circumcision as urinary tract infection preventative

[Nowhere in the article does any doctor urge any such thing.] By Sheryl Ubelacker
Urinary tract infections are far more common in uncircumcised boys than in their circumcised counterparts, but whether their foreskin is tight or more retractable makes no difference in how prone they are to becoming infected, a study suggests.

Data has shown that uncircumcised boys have a 10-fold higher risk of getting a urinary tract infection, compared to those who have had their foreskins removed.
[The "10-fold" figure seems to come from Wiswell, whose research is distinctly dubious. A meta-analysis of studies - including Wiswell's - found that it would take 111 circumcisions to prevent one UTI.]

Some previous research has suggested that the increased risk might not be related only to a boy being uncircumcised, but also to whether his foreskin is tight or more retractable. A new study, led by Montreal's Dr. Sasha Dubrovsky, set out to find out if there is any correlation.

The study found the risk of getting a urinary tract infection was pretty much equal among uncircumcised boys, no matter the state of their foreskin, said Dubrovsky, a pediatrician at Montreal Children's Hospital.
[From the study: "Of the 393 boys included in the analysis, 40 were uncircumcised with a completely visible meatus, 269 had a partially (106) or nonvisible (163) meatus, and 84 were circumcised." That's 21.4% circumcised in this convenience sample, 6.6 times as high as the circumcision rate in Quebec; 3.2% in 2003 and trending down, according to Régie de l'assurance-maladie du Québec. Their sampling method enhances this effect: if anything, non-circumcised boys would be more likely to be referred for testing than circumcised boys.

Singh-Grewal et al found it would take 111 circumcisions to prevent one UTI.

Dubrovsky found that 4.8% of circumcised boys in his sample had positive urine culture compared to 25% of intact boys. This does not translate into a real-world comparison because of all the convenience sampling, but if it did, that would reduce the much-touted 10-fold reduction of UTIs to a 5.2-fold reduction, and presumably double the Number Needed to Treat.]

"So whether they had a tight foreskin or not a tight foreskin, it didn't change that risk."
[Which casts more doubt on the hypothesis that circumcision prevents UTIs.]

The issue is of particular importance for doctors when diagnosing children brought to the emergency department with symptoms of a possible UTI, one of the most common and serious bacterial infections in children, say the authors, whose study was published Monday in the Canadian Medical Association Journal.
"The interesting part of the article is that many of us were under the misconception that it was the covered penis, and primarily the urethra, that was responsible for infant males' urinary tract infections," said Dr. Martin Koyle, a pediatric urologist at Toronto's Hospital for Sick Children.

"And we thought that once the foreskin retracted, that risk was no longer there. This article seems to refute that."
[It actually seems to refute that circumcision has anything to do with UTIs.]
If left untreated, UTIs can cause a potentially fatal infection of the blood; repeated untreated infections over time can leave the kidneys scarred, potentially leading to renal failure in adulthood. [Shroud-waving. So don't leave them untreated!]

When young children are brought to the ER with persistent fever, doctors must consider whether they are dealing with a cold or other virus that will likely run its course or a potentially serious bacterial infection requiring treatment, Dubrovsky said from Montreal.

"And nowadays, in the postvaccine era, the most common serious bacterial infection is the urinary tract infection," he said. "So we'd like to have some methods of figuring out who is that high-risk kid when we're seeing them."

There are a number of guidelines on how to stratify the risk, among them circumcision status, Dubrovsky said. "Our study just confirms that it is uncircumcised, period, not uncircumcised boys with a tight foreskin. So one does not need to consider the retractability of the foreskin or how tight it is. That has no bearing on it."

He said uncircumcised boys are more prone to UTIs because the bacteria that cause them tend to stick to area and multiply, especially when children are in diapers that hold in heat and moisture. [This is pure conjecture if there is not in fact a correlation.] "The kids who do get urinary tract infections, it's not a question of cleanliness versus not cleanliness. It's a part of life, it's just one of those things that happen," he said, offering this advice to parents of uncircumcised boys: "You give them their bath, you don't need to retract anything, pull anything. Nothing should ever hurt when washing that area."
[Several other studies spun the study to "Circumcision prevents UTIs" but no other went so far as fabricating a recommendation.

Atypically, Fox News has got the body of the story almost right.

It still gets the subject wrong: "Study confirms uncircumcised boys' UTI risk".

But it does say, "But [UTIs'] absolute risk is still low, said Dr. Alexander Sasha Dubrovsky, the lead researcher on the new study. ... According to the American Academy of Pediatrics (AAP), an uncircumcised boy has about a one in 100 chance of developing a UTI in his first year of life. The risk for a circumcised baby is one in 1,000. ...Dubrovsky stressed that the study was not set up to inform the debate over circumcision. ... "Our study doesn't answer any questions on the potential benefits of routine circumcision," Dubrovsky said.]

1 comment:

  1. This ambitious but misdirected article pursues a dubious study performed years ago - that 1% of uncircumcised boys are more apt to experience urinary tract infection - while missing the most important consequence of circumcision: that over nine percent of circumcised boys develop meatal stenosis.

    Fact is that Wiswell's UTI study was based on a comparison between healthy circumcised, full-term babies and premature babies who were not circumcised because they were too weak and sickly at birth, so that circumcision was prevented or at least postponed. Comparing these two populations and attributing the results to the circumcision factor skewed the results. An accurate result would be more likely if healthy, full-term babies were compared one to another.

    Wiswell's findings could be stated more accurately, "Premature babies develop more UTIs than full-term babies." His work is not something you want to base research on.