Towards evidence based circumcision of English boys: survey of trends in practice

Rickwood, A. M. K.; Kenny, Simon; Donnell, Steve C.

doi:10.1136/bmj.321.7264.792

Cited by 72 publications

(42 citation statements)

References 4 publications

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“…Although once thought to affect only 1% of boys, (90) recent histological examination of the prepuce from 1178 boys circumcised for phimosis found BXO in 40%. (91) Of these, 19%…”

Section: Balanoposthitismentioning

confidence: 99%

Why circumcision is a biomedical imperative for the 21^stcentury

Morris

2007

BioEssays

101

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Circumcision of males represents a surgical “vaccine“ against a wide variety of infections, adverse medical conditions and potentially fatal diseases over their lifetime, and also protects their sexual partners. In experienced hands, this common, inexpensive procedure is very safe, can be pain‐free and can be performed at any age. The benefits vastly outweigh risks. The enormous public health benefits include protection from urinary tract infections, sexually transmitted HIV, HPV, syphilis and chancroid, penile and prostate cancer, phimosis, thrush, and inflammatory dermatoses. In women circumcision of the male partner provides substantial protection from cervical cancer and chlamydia. Circumcision has socio‐sexual benefits and reduces sexual problems with age. It has no adverse effect on penile sensitivity, function, or sensation during sexual arousal. Most women prefer the circumcised penis for appearance, hygiene and sex. Given the convincing epidemiological evidence and biological support, routine circumcision should be highly recommended by all health professionals. BioEssays 29:1147–1158, 2007. © 2007 Wiley Periodicals, Inc.

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“…Although once thought to affect only 1% of boys, (90) recent histological examination of the prepuce from 1178 boys circumcised for phimosis found BXO in 40%. (91) Of these, 19%…”

Section: Balanoposthitismentioning

confidence: 99%

Why circumcision is a biomedical imperative for the 21^stcentury

Morris

2007

BioEssays

101

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“…These studies have been criticized on methodological grounds, and there is no universal acceptance that circumcision prevents the development of UTI [10,11,12]. The aim of this study was to determine whether circumcision decreases the risk of significant bacteriuria and prevents recurrence.…”

Section: Introductionmentioning

confidence: 99%

Circumcision for the prevention of significant bacteriuria in boys

Nayır¹

2001

Pediatr Nephrol

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The aim of this study was to determine whether circumcision affects significant bacteriuria in boys. During a 60-month prospective study, 100 boys with microbiologically confirmed symptomatic urinary tract infection (UTI) were evaluated. Twelve patients with abnormal ultrasonography findings were excluded from the study. Eighteen of the boys had not been circumcised due to parental choice. The remaining 70 boys with normal renal ultrasonography were randomly allocated into two groups. In the first group 35 boys ranging in age from 6 months to 10 years (mean 33.2+/-30.9 months) were observed for 6 months and urinary cultures were taken monthly. When they had a positive urine culture (with or without any symptoms), they received antibiotic treatment. After 6 months they were circumcised and then observed for another 6-month period. Group 2 comprised 35 boys aged from 3 months to 9 years (mean 29.1+/-36.7 months). They were circumcised immediately after the first UTI and were followed for 6 months. Urine samples were obtained by the bag technique in infants and by the mid-stream technique in older patients. In the uncircumcised group, the rate of significant bacteriuria per patient did not change in two 6-month follow-up periods (3.46+/-0.91 and 3.33+/-0.97 episodes). In group 1, the rate of positive urine cultures dropped from 3.57+/-1.11 to 0.14+/-0.35 episodes after circumcision (P<0.001). In the second group, the rate of significant bacteriuria was 0.17+/-0.38 episodes after circumcision. Among the uncircumcised patients, symptomatic UTI was observed in 6 cases (3 cases in the first period of group 1, 1 case in the first and 2 cases in the second period of the uncircumcised group), whereas after circumcision no patient had symptomatic UTI. The mean age at circumcision was 42.7+/-28.4 months. No complication due to circumcision occurred in any patient. UTI may also occur in boys after the 1st year of life. The present study indicated that circumcision in boys decreases the rate of positive urine cultures. Therefore circumcision could be considered as a part of UTI therapy.

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“…The RACP Statement in saying the rate of phimosis is 'at least 1%' is referring to secondary cicatrisation of the foreskin due to balanitis xerotica obliterans (i.e. pathological phimosis in which the orifice is constricted from skin dryness, shrinkage and atrophy), 55 as opposed to an anatomically narrow orifice, which is what is usually meant by phimosis. 56,57 The rate of phimosis is not disclosed in the Statement, but, as reviewed by Bailis 56 and Cox, 57 has been reported as 20% at age 5-13, 58 8% at age 8, 54 14% amongst British soldiers, 59 and 9% in German youths 60 and men.…”

Section: Phimosismentioning

confidence: 99%

RACP's policy statement on infant male circumcision is ill‐conceived

Morris

Bailis²,

Castellsagué

et al. 2006

Australian and New Zealand Journal of Public Health

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Objective:To conduct a critical peer‐review of the 2004 Policy Statement on routine male circumcision produced by the Royal Australasian College of Physicians (RACP). Method:Comprehensive evaluation in the context of the research field. Results:We find that the current Statement downplays the wide‐ranging life‐long benefits of circumcision in prevention of urinary tract infections (UTIs), penile and cervical cancer, genital herpes and chlamydia in women, HIV infection, phimosis, and various penile dermatoses, and at the same time overstates the complication rate. We highlight the many errors in the RACP Statement and note that it sidesteps making a conclusion based on circumcision's well‐documented prophylactic health benefits by instead referring to the status of the foreskin at birth. In the era of preventative medicine we view this as irresponsible. Conclusion:The RACP's Statement on routine male circumcision is not evidence‐based and should be retracted. Implications:In the interests of public health and individual well‐being an extensive, comprehensive, evidence‐based revision should be conducted so as to provide scientifically accurate, balanced information on the advantages, and also the low rate of mostly minor complications, associated with this simple procedure, which for maximum benefits and minimal risk should ideally be performed in the neonatal period.

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Towards evidence based circumcision of English boys: survey of trends in practice

Cited by 72 publications

References 4 publications

Why circumcision is a biomedical imperative for the 21^stcentury

Why circumcision is a biomedical imperative for the 21^stcentury

Circumcision for the prevention of significant bacteriuria in boys

RACP's policy statement on infant male circumcision is ill‐conceived

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Towards evidence based circumcision of English boys: survey of trends in practice

Cited by 72 publications

References 4 publications

Why circumcision is a biomedical imperative for the 21stcentury

Why circumcision is a biomedical imperative for the 21stcentury

Circumcision for the prevention of significant bacteriuria in boys

RACP's policy statement on infant male circumcision is ill‐conceived

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Product

Resources

About

Why circumcision is a biomedical imperative for the 21^stcentury

Why circumcision is a biomedical imperative for the 21^stcentury