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Commentary on the paper by Singh-Grewal et al (see page 853)
Almost 20 years ago, Wiswell and colleagues1 found that uncircumcised infant boys had a 10-fold greater likelihood of having urinary tract infection (UTI) in the first year of life than boys who had been circumcised as newborns. That finding has been repeatedly confirmed, and the protective effect of newborn circumcision against UTI is well established, as documented in a 1992 meta-analysis of nine separate studies.1 A report from Sweden—where newborn circumcision is unusual—showed a preponderance of UTI in male infants,2 although UTI is much more common in older girls. The procedure at issue is newborn circumcision, because the younger the infant, the more likely and severe is the UTI and the greater the danger of sepsis and death. UTIs in infants manifest as pyelonephritis with high fever, usually requiring hospital admission and parenteral therapy, whereas UTI which develops later in life (usually cystitis) is milder and more easily treated. Imaging studies conducted after UTI in infants has resolved often show evidence of renal damage with scarring.3 In a 1997 Commentary in this journal, I indicated that Europe, in opposing circumcision, was ignoring compelling medical evidence.4 The reply concerning UTI was …
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