Friday, November 8, 2013

Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies

Circumcision, as a prophylactic measure for ‘medical conditions’, remains controversial.
This stringent and well-structured review finds that circumcision leads to a
decreased rate of urinary tract infections in boys. The authors acknowledge that it is
let down by the poor quality of the studies analysed, but few would disagree with
the paper’s findings. The interpretation of these findings, and how this should
influence clinical practice, is a more interesting topic.
This is well demonstrated by the conflicting perspectives published with the
article. Schoen’s |1| interpretation, a US author, is that this study backs routine
newborn circumcision for all boys, suggesting that the author’s summary is
‘analogous to postponing immunization of an infant until the child is exposed to
the pathogen or is diagnosed with the disease’. In contrast,Malone |2|, a UK author,
agrees with Sing-Grewal et al. that circumcision should be reserved for those boys
with recurrent UTI or those at increased risk of UTI.
Sing-Grewal D, Macclessi J, Craig J. Arch Dis Child 2005; 90: 853–8

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