Dario Prais, Rachel Shoov-Furman, and Jacob Amir

Is ritual circumcision a risk factor for neonatal urinary tract infections?
Arch Dis Child 2008; 0: adc.2008.144063v1 [Abstract]

weingml{at}post.tau.ac.il Michael A Weingarten

Prais et. al. present data showing an odds ratio of 2.8 for hopitalization for urinary infection after circumcision by a traditional mohel as compared to a medical practitioner. The 95% confidence interval includes 1 and the p value is 0.06. The authors, admitting that the results do not reach statistical significance, suggest that a larger study would strengthen the finding. They do not admit that a larger study might equally well weaken the finding. Furthermore, their estimate of the frequency of ritual versus medical circumcision in the population was based on a sample from the Rabin Medical Centre, sited in the relatively modern and secular central region of Israel where medical circumcision might well be more popular, as compared to the other regions of the country which were included in their survey of hospitalizations for post- circumcision urinary infection. This bias could invalidate the results altogether. The conclusion that ritual circumcision places the infant at increased risk of urinary infection, attributed to poor dressing techniques, is not sustained by the data and is suspect due to sampling bias.