Background: Neonatal urinary tract infection (UTI) is more frequent in males than in females. However, circumcised males are known to have less UTIs compared to uncircumcised neonates. Unexpectedly, an increase in the incidence of UTI during the first weeks after ritual Jewish circumcision has been reported. The hemostasis technique in Jewish circumcision is wrapping the penis in a strip of gauze for a few hours while in surgical circumcision there is no wrapping. Our aim was to evaluate if there is a relationship between techniques of circumcision and development of subsequent UTIs, and if length of time of wrapping is a possible risk factor.
Patients and Methods: We prospectively evaluated all circumcised infants hospitalized due to UTI during the first 4 weeks post-circumcision. The circumcision technique and the duration time of shaft wrapping were compared to the control group of healthy babies born during Jan-Feb 2000 at Rabin Medical Center.
Results: Study group included 37 babies with UTI, mean age, 18 days; 32 (86.5%) had traditional circumcision and 5 (13.5%) had a surgical procedure. In the control group that included 45 babies; significantly less children had traditional circumcision, 31 (69%), and 14 (31%) a surgical procedure (p=0.05). The mean duration of the hemostatis was 25±23 hours in the study group and 15±11.8 in the control group (p=0.02 - t test) (p=0.055 - Mann-Whitney test). E. coli was isolated in approximately 80% of UTIs, Klebsiella in 15% and 5% other bacteria. Renal ultrasound and post-voiding urethrocystography performed in the study group revealed anomalies in 7% of cases.
Conclusion: After ritual circumcision there is a higher incidence of UTI. Shaft wrapping seems to be a risk factor for development of UTI.