Neonatal Circumcision: An End to the Controversy?

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Abstract
The incidence of urinary tract infections is 10 times higher in the uncircumcised male than in those circumcised. An extensive review of bacterial adherence, the initiating factor in urinary tract infections, is presented to show that bacterial adherence to the prepuce is necessary for pyelonephritis to occur. Colonization with maternal bacteria occurs at birth; thus the incidence of pyelonephritis in infants born of bacteriuric mothers is much higher than it is in infants born of nonbacteriuric mothers. The significant morbidity of acute pyelonephritis in infants is one reason for encouraging neonatal circumcision, but a more important reason is that acute pyelonephritis in the first years of life often leads to significant renal damage that may progress to end-stage renal disease during adolescence. Since circumcision can now be done under local anesthesia, the newborn infant can have a painless prophylactic operation that will prevent urinary tract infections, pyelonephritis, and end-stage renal disease.

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