Circumcision and urinary tract abnormalities.

Abstract

Sir .—In the March 1989 issue of AJDC , Herzog 1 presented reports of 36 infants with positive urine culture during routine workup for acute illness. All these infants were uncircumcised, whereas this was true only for 32% of the control population. Of the 31 infants who underwent roentgenographic studies, 4 had grade II and 2 grade IV reflux, 1 had posterior urethral valve with hydronephrosis, and 1 had ureteropelvic junction obstruction and hydronephrosis. The authors concluded that noncircumcision is a highly significant risk factor for UTI in infants. There is a recent surge of interest and controversy about the association of infantile UTI and periurethral bacterial flora with noncircumcision. 2-14 On one side of the spectrum circumcision is considered to be a prophylactic measure against UTI in infants (Wiswell and his collaborators 3,8,10,13,14 ), while on the other, the need to perform surgery on 96 to 98 infants to prevent two to