Send letter to journal:
Re: Breastfeeding is best for reducing UTI

To the Editor:

Singh-Grewal et al.¹ confirm earlier findings that the complications and disadvantages of male neonatal circumcision outweigh any possible health benefit and, therefore, non-circumcision produces the highest medical utility.^2,3

Unfortunately, their report on urinary tract infection (UTI) is incomplete because they have failed to mention the value of breastfeeding in reducing UTI in infants.¹ Pisacane et al. report that breastfed infants have a relative risk of 0.38 compared to those infants who are fed with breastmilk substitute, a 62 percent reduction.⁴ This is caused by oligosaccharides that prevent adhesion of pathogens to uroepithelial tissue.⁵ Marild et al. report that the protective effect of breastfeeding continues after weaning.⁶

Breastfeeding is free of the complications associated with circumcision. The American Academy of Pediatrics recommends breastfeeding, not circumcision, to reduce the incidence of UTI and other infections.⁷

George C. Denniston, MD, MPH
President

George Hill, Bioethicist
Executive Secretary
Doctors Opposing Circumcision
Suite 42
2442 NW Market Street
Seattle, Washington 98107-4137
USA.

Website: http://www.doctorsopposingcircumcision.org

References:

1. Craig J. Circumcision for the prevention of urinary tract infection in boys: A systematic review of randomized trials and observational studies. Arch Dis Child 2005. [Abstract]
2. Chessare JB. Circumcision: Is the risk of urinary tract infection really the pivotal issue?. Clin Pediatr 1992;31(2):100-4.
3. Van Howe RS. A cost-utility analysis of neonatal circumcision. Med Decis Making 2004;24:584-601. [Abstract]
4. Pisacane A, Graziano L, Mazzarella G, et al. Breast-feeding and urinary tract infection. J Pediatr 1992;120:87-89.
5. Coppa GV, Gabrielli O, Giorgi P, et al. Preliminary study of breastfeeding and bacterial adhesion to uroepithelial cells. Lancet 1990;335:569-71.
6. Marild S, Hansson S, Jodal U, Oden A, Svedberg K. Protective effect of breastfeeding against urinary tract infection. Acta Paediatr 2004;93(2):154-6.
[Abstract]
7. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2005;115(2):496-506. [Fulltext]

Send letter to journal:
Re: Don't ever forget constipation

Dear Editor,

We read with great interest the article by D Singh-Grewal et al.[1] regarding the value of circumcision for the prevention of recurrent UTIs in boys.

The article presents a reasonable case for considering circumcision in some boys with recurrent UTIs.

However, we would like to bring to the authors’/readers’ attention that both the original article and the quoted papers[2] make no mention that chronic constipation is a risk factor for recurrent UTIs in childhood.

Chronic constipation is a well-recognised and common risk factor in children with recurrent UTIs. There is good evidence supporting this relationship.[3]

Recognition and successful treatment of chronic constipation plays an important role in the management of children with recurrent UTIs.

A study of this relationship by Vera Loening-Baucke in 1997 concluded that “relief of constipation resulted in the disappearance of recurrent urinary tract infections in all patients who had no anatomical abnormality of the urinary tract.”[3]

This cause and effect relationship is supported by numerous other studies going back to the 1970s.[4-7]

A recurring theme is that often the relationship between recurrent UTIs and chronic constipation is not considered by either health care professionals or the children’s carers.

Hence, it should not be forgotten that in children with recurrent UTIs, chronic constipation is a major risk factor and should therefore be considered in all cases.

References

1. Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trails and observational studies. Arch Dis Child 2005;90:853 - 858.

2. Nayir A. Circumscision for the prevention of significant bacturia in boys. Paediatr Nephrol 2001;16:1129 -1134.

3. Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics 1997;100(2 Pt 1):228-32.

4. Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol 1998;160(3 Pt 2):1019-22.

5. Baker SS, Liptak GS, Colletti RB, Croffie JM, Di Lorenzo C, Ector W, et al. Constipation in infants and children: evaluation and treatment. A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 1999;29(5):612-26.

6. Blethyn AJ, Jenkins HR, Roberts R, Verrier Jones K. Radiological evidence of constipation in urinary tract infection. Arch Dis Child 1995;73(6):534-5.