THE PREPUCE: A MISTAKE OF NATURE?
SUMMARY:
Retrospective studies suggest that circumcision of newborn boys will reduce the frequency of male early infantile urinary tract infection by about 90%.
If they are correct, this will be the first known instance of a common potentially lethal disease being preventable by extirpation of a piece of normal tissue.
If they are correct, this will be the first known instance of a common potentially lethal disease being preventable by extirpation of a piece of normal tissue.
To reconcile the phenomenon with existing views of evolution and biology, it is suggested that the effects of one unphysiological intervention are counterbalancing those of another - ie, colonisation of the babies gastrointestinal tract and genitals in maternity units by Escherichia coli strains of non-maternal origin, to which the baby has no passive immunity.
As an alternative to circumcision to prevent early infantile male UTI, more natural colonisation could be promoted by strict rooming in of mother and baby or by active colonisation of the baby with his mother's anaerobic gut flora.
INTRODUCTION:
CIRCUMCISION in the neonatal period may reduce the frequency of male urinary tract infection (UTI) by some 90%.
These sensational findings are reported by 'Wiswell et al' in studies of more than 200,000 babies.
Although retrospective, the evidence is persuasive.
These sensational findings are reported by 'Wiswell et al' in studies of more than 200,000 babies.
Although retrospective, the evidence is persuasive.
Moreover, Ginsburg and McCracken report that 95% of male infantile UTI occurred in uncircumcised boys.
With a circumcision rate of about 80%, this distribution between circumcised and non-circumcised boys could not be random.
In addition, in the international reflux study comprising about 600 cases with UTI, there are 9.9 males in the American link but 22.7% males in the European link (Olbing H, personal communication).
Since circumcision in the newborn period is rare in Europe but common in the USA, this is further evidence for the role of the prepuce in the pathogenesis of neonatal UTI.
These data are of immediate importance in the USA, general circumcision might prevent 20,000 attacks of pyelonephritis in male infants per year.
They are also of interest from other points of view.
Firstly, they could bring to an end the old controversy concerning the infection route in neonatal UTI.
The studies by Wiswell et al suggest that even neonatal infections are often ascending and not blood-borne.
Secondly they indicate that, as in girls, the external genitals of boys are important in the pathogenesis of UTI.
Thirdly, this is the first demonstration of effective prevention of UTI by means other than long-term administration of antibiotics.
Fourthly, the findings raise questions of general biological interest since they indicate that a common potentially lethal disease, early infantile male UTI, can be prevented by extirpation of a piece of normal, healthy tissue of universal occurrence in males.
It would not be easy to find a parallel in medicine or biology.
That the prepuce is a mistake of Nature seems improbable, and we offer here an alternative explanation.
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