Nessun rischio di infezioni al tratto urinario per bambini non circoncisi
Research
Alexander Sasha
Dubrovsky,
Bethany J. Foster,
Roman Jednak,
Elise Mok,
and David
McGillivray
Visibility of the urethral meatus
and risk of urinary tract infections in uncircumcised boys CMAJ cmaj.111372;
published ahead of print July 9, 2012, doi:10.1503/cmaj.111372
Visibility of the urethral
meatus and risk of urinary tract infections in uncircumcised
boys
This study does not provide evidence that intact
children have an increased risk of urinary tract infections (UTIs). To
demonstrate an increased risk of UTIs, larger demographic data would be
required. The intact-to-circumcised ratio of all children living within the
hospital's catchment area would need to be determined and correlated with the
results of the positive urine cultures. In addition, all UTIs diagnosed outside
the emergency department would also need to be included, as well as the
circumcision status of each of those children.
Abstract
Canadian Medical
Association
Background:
Uncircumcised boys are at higher risk for urinary tract infections than
circumcised boys. Whether this risk varies with the visibility of the urethral
meatus is not known. Our aim was to determine whether there is a hierarchy of
risk among uncircumcised boys whose urethral meatuses are visible to differing
degrees.
Methods: We conducted a
prospective cross-sectional study in one pediatric emergency department. We
screened 440 circumcised and uncircumcised boys. Of these, 393 boys who were not
toilet trained and for whom the treating physician had requested a catheter
urine culture were included in our analysis. At the time of catheter insertion,
a nurse characterized the visibility of the urethral meatus (phimosis) using a
3-point scale (completely visible, partially visible or nonvisible). Our primary
outcome was urinary tract infection, and our primary exposure variable was the
degree of phimosis: completely visible versus partially or nonvisible urethral
meatus.
Results: Cultures grew
from urine samples from 30.0% of uncircumcised boys with a completely visible
meatus, and from 23.8% of those with a partially or nonvisible meatus (p = 0.4).
The unadjusted odds ratio (OR) for culture growth was 0.73 (95% confidence
interval [CI] 0.35–1.52), and the adjusted OR was 0.41 (95% CI 0.17–0.95). Of
the boys who were circumcised, 4.8% had urinary tract infections, which was
significantly lower than the rate among uncircumcised boys with a completely
visible urethral meatus (unadjusted OR 0.12 [95% CI 0.04–0.39], adjusted OR 0.07
[95% CI 0.02–0.26]).
Conclusion: We did not
see variation in the risk of urinary tract infection with the visibility of the
urethral meatus among uncircumcised boys.
Funding:
This study received funding from the Montreal
Children’s Hospital
Research Institute Clinical Projects Funding Competition for fellowship
projects. The study sponsors had no role in the design of the study, the
collection, analysis or interpretation of data, the writing of the report or the
decision to submit the article for publication.
From the Divisions of Pediatric Emergency
Medicine
(Dubrovsky, McGillivray), Pediatric Nephrology
(Foster), Pediatric Urology
(Jednak), the Department of Epidemiology,
Biostatistics and Occupational
Health (Foster)
and Montreal Children’s Hospital Clinical Research
Centre
(Mok), Montréal Children’s Hospital, McGill University
Health
Centre, Montréal, Que.
There are often complex
psychological motivations among some physicians and researchers who compulsively
search for "a priori" medical justifications in order to perpetuate infant
circumcision. Even if circumcision provided 100% protection against UTIs, this
practice could never be justified based on the ethical principle of
proportionality - there are effective and less destructive therapies available
for preventing and treating urinary tract infections which do not involve the
prophylactic removal of healthy genital tissue.
Yes, little boys will
sometimes develop UTIs. As with little girls, they should be treated
appropriately with antibiotics, not with prophylactic surgery. Are we to believe
that non-circumcising countries like Sweden, Finland, Denmark, Norway and Japan
struggle with significant public health problems related to infant UTIs? If so,
why aren't physicians from these nations promoting circumcision as an effective
and ethical prevention strategy? Perhaps, they do not share the same irrational
fear and loathing of the prepuce as some North American physicians? Circumcision
prevents urinary tract infections the same way garlic prevents
vampires.
Circumcision was only medicalized during the Victorian era as a
misguided attempt to curb masturbation. It was widely promoted by physicians as
a means of decreasing sexual pleasure and disrupting the normal gliding
mechanism of the penis. We now understand that the prepuce is richly innervated,
erogenous tissue which enhances sexual pleasure. In addition, the prepuce
provides a unique linear gliding mechanism during sexual intercourse. As
physicians, we have no right to amputate this functional tissue from powerless
infants without medical urgency.
This study illustrates how our endless
appetite for evidence-based medicine can sometimes distract us from the ethical
and moral responsibilities of our profession. Prophylactic circumcision is
medically unethical because it violates the child's fundamental human right to
bodily integrity. Non-therapeutic circumcision is a disgrace to our profession.
Canadian physicians have a moral obligation to oppose this cruel practice and
properly educate the public about the sexual function and proper care of the
prepuce. (Published July 19,
2012)
Circoncisione non riduce rischio di clamidia o gonorrea
J Infect Dis. Aug 1 2009;
200(3):370-8.
Adult male circumcision does not reduce the risk of incident Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis infection: results from a randomized, controlled trial in Kenya.
Mehta SD, Moses S, Agot K, Parker C, Ndinya-Achola JO, Maclean I, Bailey RC.
Source
Department of Epidemiology, University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA. supriyad@uic.edu
Abstract
BACKGROUND:
We examined the effect of male circumcision on the acquisition of 3 nonulcerative sexually transmitted infections (STIs).
METHODS:
We evaluated the incidence of STI among men aged 18-24 years enrolled in a randomized trial of circumcision to prevent human immunodeficiency virus (HIV) infection in Kisumu, Kenya. The outcome was first incident nonulcerative STI during 2 years of follow-up. STIs examined were laboratory-detected Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis infection.
RESULTS:
There were 342 incident infections among 2655 men followed up. The incidences of infection due to N. gonorrhoeae, C. trachomatis, and T. vaginalis were 3.48, 4.55, and 1.32 cases per 100 person-years, respectively. The combined incidence of N. gonorrhoeae and C. trachomatis infection was 7.26 cases per 100 person-years (95% confidence interval, 6.49-8.13 cases per 100 person-years). The incidences of these STIs, individually or combined, did not differ by circumcision status as a time-dependent variable or a fixed variable based on assignment. Risks for incident STIs in multivariate analysis included an STI at enrollment, multiple sex partners within <30 days, and sexual intercourse during menses in the previous 6 months; condom use was protective.
CONCLUSIONS:
Circumcision of men in this population did not reduce their risk of acquiring these nonulcerative STIs. Improved STI control will require more-effective STI management, including partner treatment and behavioral risk reduction counseling.
FONTE: www.ncbi.nlm.nih.gov/pubmed/19545209
Adult male circumcision does not reduce the risk of incident Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis infection: results from a randomized, controlled trial in Kenya.
Mehta SD, Moses S, Agot K, Parker C, Ndinya-Achola JO, Maclean I, Bailey RC.
Source
Department of Epidemiology, University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA. supriyad@uic.edu
Abstract
BACKGROUND:
We examined the effect of male circumcision on the acquisition of 3 nonulcerative sexually transmitted infections (STIs).
METHODS:
We evaluated the incidence of STI among men aged 18-24 years enrolled in a randomized trial of circumcision to prevent human immunodeficiency virus (HIV) infection in Kisumu, Kenya. The outcome was first incident nonulcerative STI during 2 years of follow-up. STIs examined were laboratory-detected Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis infection.
RESULTS:
There were 342 incident infections among 2655 men followed up. The incidences of infection due to N. gonorrhoeae, C. trachomatis, and T. vaginalis were 3.48, 4.55, and 1.32 cases per 100 person-years, respectively. The combined incidence of N. gonorrhoeae and C. trachomatis infection was 7.26 cases per 100 person-years (95% confidence interval, 6.49-8.13 cases per 100 person-years). The incidences of these STIs, individually or combined, did not differ by circumcision status as a time-dependent variable or a fixed variable based on assignment. Risks for incident STIs in multivariate analysis included an STI at enrollment, multiple sex partners within <30 days, and sexual intercourse during menses in the previous 6 months; condom use was protective.
CONCLUSIONS:
Circumcision of men in this population did not reduce their risk of acquiring these nonulcerative STIs. Improved STI control will require more-effective STI management, including partner treatment and behavioral risk reduction counseling.
FONTE: www.ncbi.nlm.nih.gov/pubmed/19545209
J Pediatr Surg. 2012
Apr;47(4):756-9.
Foreskin preputioplasty and intralesional triamcinolone: a valid alternative to circumcision for balanitis xerotica obliterans.
Wilkinson DJ, Lansdale N, Everitt LH, Marven SS, Walker J, Shawis RN, Roberts JP, Mackinnon AE, Godbole PP.
Source: Paediatric Surgical Unit, Sheffield Children's Hospital NHS Foundation Trust, UK. d.wilkinson@liv.ac.uk
Abstract
BACKGROUND:
We previously reported our short-term experience of foreskin preputioplasty as an alternative to circumcision for the treatment of foreskin balanitis xerotica obliterans (BXO). In this study, we aimed to compare this technique with circumcision over a longer period.
METHODS:
Between 2002 and 2007, boys requiring surgery for BXO were offered either foreskin preputioplasty or primary circumcision. The preputioplasty technique involved triradiate preputial incisions and injection of triamcinolone intralesionally. Retrospective case-note analysis was performed to identify patient demographics, symptoms, and outcomes.
RESULTS:
One hundred thirty-six boys underwent primary surgery for histologically confirmed BXO. One hundred four boys opted for foreskin preputioplasty, and 32, for circumcision. At a median follow-up of 14 months (interquartile range, 2.5-17.8), 84 (81%) of 104 in the preputioplasty group had a fully retractile and no macroscopic evidence of BXO. Of 104, 14 (13%) developed recurrent symptoms/BXO requiring circumcision or repeat foreskin preputioplasty. In the circumcision group, 23 (72%) of 32 had no macroscopic evidence of BXO. The incidence of meatal stenosis was significantly less in the foreskin preputioplasty group, 6 (6%) of 104 vs 6 (19%) of 32 (P = .034).
CONCLUSION:
Our results show a good outcome for most boys undergoing foreskin preputioplasty and intralesional triamcinolone for BXO. There is a small risk of recurrent BXO, but rates of meatal stenosis may be reduced.
FONTE: www.ncbi.nlm.nih.gov/pubmed/22498393
Foreskin preputioplasty and intralesional triamcinolone: a valid alternative to circumcision for balanitis xerotica obliterans.
Wilkinson DJ, Lansdale N, Everitt LH, Marven SS, Walker J, Shawis RN, Roberts JP, Mackinnon AE, Godbole PP.
Source: Paediatric Surgical Unit, Sheffield Children's Hospital NHS Foundation Trust, UK. d.wilkinson@liv.ac.uk
Abstract
BACKGROUND:
We previously reported our short-term experience of foreskin preputioplasty as an alternative to circumcision for the treatment of foreskin balanitis xerotica obliterans (BXO). In this study, we aimed to compare this technique with circumcision over a longer period.
METHODS:
Between 2002 and 2007, boys requiring surgery for BXO were offered either foreskin preputioplasty or primary circumcision. The preputioplasty technique involved triradiate preputial incisions and injection of triamcinolone intralesionally. Retrospective case-note analysis was performed to identify patient demographics, symptoms, and outcomes.
RESULTS:
One hundred thirty-six boys underwent primary surgery for histologically confirmed BXO. One hundred four boys opted for foreskin preputioplasty, and 32, for circumcision. At a median follow-up of 14 months (interquartile range, 2.5-17.8), 84 (81%) of 104 in the preputioplasty group had a fully retractile and no macroscopic evidence of BXO. Of 104, 14 (13%) developed recurrent symptoms/BXO requiring circumcision or repeat foreskin preputioplasty. In the circumcision group, 23 (72%) of 32 had no macroscopic evidence of BXO. The incidence of meatal stenosis was significantly less in the foreskin preputioplasty group, 6 (6%) of 104 vs 6 (19%) of 32 (P = .034).
CONCLUSION:
Our results show a good outcome for most boys undergoing foreskin preputioplasty and intralesional triamcinolone for BXO. There is a small risk of recurrent BXO, but rates of meatal stenosis may be reduced.
FONTE: www.ncbi.nlm.nih.gov/pubmed/22498393
