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Old 03-16-2012, 08:57 AM   #1
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A Question about Circumcision (yes, a real question!)

I recently found out that I am pregnant with #2. Our first has a condition called Vesicouteral Reflux (also referred to as Kidney reflux) where the tubes between her kidney and bladder (the ureters) don't work correctly and instead of sending urine from the kidney to the bladder and out of the body, the urine is recycled through again and again. Our daughter got her first UTI at 2 weeks old and was hospitalized for a very long time for such a small baby. She was put on antibiotics and kept getting sick anyway. With kidney reflux the UTIs were very serious because the infected urine was making its way to her kidneys, causing damage and scarring. Before she was a year old she had been hospitalized a dozen times, each time after proving resistant to yet another antibiotic. She had major surgery last June and went off antibiotics in January. She has been infection free since!

So that's the back story. This condition is genetic, and it is 75% more likely that our second child will have it as well. There is no way of knowing what the severity will be if #2 does have it (Sarah Jane was stage 4 on one side and stage 5 on the other, out of 5 possible stages) and obviously there are no guarntees about anything.

We had always assumed we would not circumcise, not because I have done lots of research or anything (I admittedly haven't) but because I have a sort of natural inclanation that if it was put there it should stay there unless there's a problem. IDK if that makes sense.

Well, I was reading through the last couple circ threads and saw it posted several times that non-circ'd boys are more likely to get UTIs. And it seemed like even the anti-circ' people weren't arguing with that, but more saying why it didn't matter. I'm not sure if I interpreted that correctly, but if I did, to us it DEFINITELY matters. With such a high likelihood of VR in this child, decreasing the chance of UTIs would be beneficial, I think.

So does anyone have experience with this? Anyone have some links to research answering my questions? I don't want to be flamed for this, but honestly I can take it either way. I am genuinely asking because I don't have the answers and there isn't much I wouldn't do to keep from having my second child spend its' first year in a hospital.

TIA
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Old 03-16-2012, 09:01 AM   #2
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Re: A Question about Circumcision (yes, a real question!)

Hmmm that's a good question Amie.

I have personally not know an intact boy to have a UTI but I have heard that they are more common in intact boys. In this situation I can see where you might be concerned. I don't really have an answer though. I'll see what I can find.
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Old 03-16-2012, 09:07 AM   #3
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Re: A Question about Circumcision (yes, a real question!)

Urinary tract infections
Circumcision is associated with a reduced risk of urinary tract infections (UTIs) however the magnitude of this benefit is likely to outweigh the risk only in those at high risk of UTIs.
Some UTI studies have been criticized for not taking into account a high rate of UTI's among premature infants, who are usually not circumcised because of their fragile health status. The AMA stated that "depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI," and noted one decision analysis model that concluded that circumcision was not justified as a preventative measure against UTI.
Boys are not as prone to UTIs are girls are, and the slightly higher chance of them getting one is before the age of 1. The best preventative care for a UTI is frequent diaper changes and baths, and not retracting the foreskin.
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Old 03-16-2012, 03:46 PM   #4
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Re: A Question about Circumcision (yes, a real question!)

Quote:
Originally Posted by bigmamakelsey View Post
Urinary tract infections
Circumcision is associated with a reduced risk of urinary tract infections (UTIs) however the magnitude of this benefit is likely to outweigh the risk only in those at high risk of UTIs.
Some UTI studies have been criticized for not taking into account a high rate of UTI's among premature infants, who are usually not circumcised because of their fragile health status. The AMA stated that "depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI," and noted one decision analysis model that concluded that circumcision was not justified as a preventative measure against UTI.
Boys are not as prone to UTIs are girls are, and the slightly higher chance of them getting one is before the age of 1. The best preventative care for a UTI is frequent diaper changes and baths, and not retracting the foreskin.
This. also, because of the disorder you're talking about, I do not believe circ would help decrease the risk of UTIs at all because it is caused by recycled urine, which would happen regardless of circ if your son has the condition.
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Old 03-16-2012, 09:09 AM   #5
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Re: A Question about Circumcision (yes, a real question!)

honestly, out of 5 boys, 2 circ'd and 3 not, only 1 (who was circ'd) has gotten a UTI....if it makes a difference, he is the one with a kidney disease. So, being circ'd didn't "help" (we circ'd out not knowing any better, not bc we knew about his kidneys). From what I understand about kidney reflux, it would have nothing to do with whether he had his foreskin or not, kwim? And I am not sure why it says (I have heard it as well) that intact boys are more likely to have UTIs, esp as the majority of the world does NOT circ. In full disclosure, the kidney disease that my son has, all my children have 50% chance of getting it at any point in life (they get it from me).
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Old 03-20-2012, 11:34 AM   #6
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Re: A Question about Circumcision (yes, a real question!)

sounds like he would have problems circ'd or not TBH. I don't think much would have to do with foreskin or not.

But there's a much lower chance of boys getting UTI's than girls anyway. But if you have a child that has a higher risk of UTI's BECAUSE they have some special condition, then it seems, you're damned if you do, damned if you don't.. KWIM? I'd personally leave it alone unless proven otherwise that it's beneficial to remove.
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Old 03-16-2012, 09:15 AM   #7
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My boys are 6.5 and 4 and neither have ever had a UTI. However, I would be concerned in your situation too, even if the risk is minuscule. I don't know what I'd decide, in all honesty, since I'm not actually in that situation. I just wanted to offer .
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Old 03-16-2012, 09:16 AM   #8
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Re: A Question about Circumcision (yes, a real question!)

This is just a guess, but it sounds like "normal" UTIs and VR UTI's are caused by different problems? The VR UTI would be caused by the recycled urine not leaving the body, right? So if you had a boy, who also had VR, the urine would recycle in him too no matter if he were circumcised or not, and would/could cause UTIs

However if the VR UTI your daughter got was introduced the same way as most "normal" UTIs (read: was not caused by VR specifically) I could see how circumcision could help your son by keeping bacteria away from the urethra since it would be uncovered ( I have heard that the foreskin can push bacteria up the urethra or trap bacteria near it, giving the bacteria easier access); although it also can be argued that the foreskin will keep the urethra clean and bacteria free on its own, so that decision is up to you, which ever way you believe

of course, this all depends on you having a boy, and if he has this condition, and the severity... but I personally believe that in your specific case it could help if in fact the lack of a foreskin does indeed keep a urethra more free of bacteria
I say this mainly because it would be important for you to avoid UTIs if possible if you were in this situation mama and good luck with whatever happens, I am sure you will do the best thing for your new LO, you sound like a very caring mama
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Old 03-16-2012, 09:27 AM   #9
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Re: A Question about Circumcision (yes, a real question!)

Quote:
Originally Posted by KB'sMama1031 View Post
This is just a guess, but it sounds like "normal" UTIs and VR UTI's are caused by different problems? The VR UTI would be caused by the recycled urine not leaving the body, right? So if you had a boy, who also had VR, the urine would recycle in him too no matter if he were circumcised or not, and would/could cause UTIs

However if the VR UTI your daughter got was introduced the same way as most "normal" UTIs (read: was not caused by VR specifically) I could see how circumcision could help your son by keeping bacteria away from the urethra since it would be uncovered ( I have heard that the foreskin can push bacteria up the urethra or trap bacteria near it, giving the bacteria easier access); although it also can be argued that the foreskin will keep the urethra clean and bacteria free on its own, so that decision is up to you, which ever way you believe

of course, this all depends on you having a boy, and if he has this condition, and the severity... but I personally believe that in your specific case it could help if in fact the lack of a foreskin does indeed keep a urethra more free of bacteria
I say this mainly because it would be important for you to avoid UTIs if possible if you were in this situation mama and good luck with whatever happens, I am sure you will do the best thing for your new LO, you sound like a very caring mama
to the bolded, this is the part that is tricky. there is no proven causation but there IS a correlation. meaning VR doesn't cause UTIs and UTIs don't cause VR, but children with VR do have a markedly higher number of UTIs than children without it. So, basically there is no answer to your question. =/

and thank you for that last bit. I of course want to do what's best for my child, and up until recently thought that meant leaving his (and we are really hoping for a boy!) genitals alone, but I don't want to make a decision that could make things worse.

I plan to talk to our daughter's urologist about this, but I wanted to do some of my own research first. He is one of the few doctors I really trust, but even the good ones don't always have the most up to date information and I want to go into it with some of my own knowledge about the subject.
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Old 03-16-2012, 09:42 AM   #10
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Re: A Question about Circumcision (yes, a real question!)

The rate of UTIs looks like this for age under 1 year:

More Common
Girls
Intact Boys
Circ Boys
Less Common

Additionally, it is not known if the UTI risks are related to the old instruction to pull back the foreskin to clean.

I would not circ for this reason. Really, you don't know that it will help, and girls are far more likely to get UTIs anyway, so if the baby is a girl, you will still have to deal with this issue.

I'd also make sure if baby is a boy and you decide to keep him intact, and he does need a cath, make sure you ask the person placing the cath if they have experience on intact penises without retracting them before you let them near him. I've heard one too many stories of boys who were retracted (which likely causes infections) because the nurse had no idea how to place a catheter without retracting.
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