Multiple studies14 comparing the prevalence of UTI in uncircumcised and circumcised male infants have shown a preponderance of UTI in uncircumcised infants. While a meta-analysis described a 12-fold increase for UTIs,14 the 1999 Task Force statement suggests the protective effect of circumcision is less (3- to 7-fold), inappropriately citing among others, the works of Shaw et al,15 Herzog,16 and Fussell et al.17 In reality, the study by Shaw et al yielded an 8-fold increased risk, the Herzog investigation demonstrated a greater than 50-fold increased risk, and the Fussell report did not even address the issue. It seems likely that the prevalence of UTI is higher than reported because it will be underdiagnosed unless urine cultures are routinely taken in evaluating febrile infants. Newman et al,18 reporting for the Pediatric Research in an Office Setting network, concluded that fewer than 50% of pediatricians performed urine culture in evaluating febrile infants <3 months old, despite the high incidence of UTI (>10%) in these infants. In a population-based study of 14 893 males born in 1996 in a closed-panel, nonprofit health maintenance organization with an effective tracking system, 2.5% (1 in 40) of uncircumcised infants developed UTI within the first year of life, most before 6 months old, and were 11 times more likely to develop UTI and 18 times more likely to be hospitalized with UTI than were circumcised infants.19 The subsequent development of renal scarring indicates that UTI in infancy may not be benign.20 As stated in "Information for Parents,"21 evidence indicates that in the first year of life uncircumcised infants have at least a 10-fold increased risk of UTI; a circumcised infant has approximately a 1 in 1000 chance of having UTI in the first year of life, whereas an uncircumcised infant has a 1 in 100 chance. In clinical terms, given that ~2 million boys are born each year in the United States, this 10-fold risk of UTI translates into 20 000 UTIs annually in the United States if all newborn boys are uncircumcised but only 2000 UTIs annually if all the boys are circumcised. Otherwise stated, newborn circumcision is >90% effective for preventing UTI, a preventive health benefit equivalent to the protective rate of many vaccines given to children.22 Despite this implication, however, the 10-fold relative risk for UTI in uncircumcised:circumcised is referred to as a "slightly lower risk."1
