Circumcisions: Again

Journal  Pediatrics, Volume 108, Issue 2, Page 552. August 2001.

Lane W, Robson M, Van Howe RS

Lack of circumcision does not cause renal failure

To the Editor.

The 1999 Circumcision Policy Statement by the Task Force on Circumcision of the American Academy of Pediatrics does not recommend routine neonatal circumcision. Notwithstanding, the need for routine neonatal circumcision continues as a controversial topic in the American pediatric literature. We read with interest the study by Schoen et al1 and the commentary by Wiswell2 on circumcision; both authors are long-time proponents of routine neonatal circumcision and have contributed much to this debate.

Wiswell continues to discuss the risk of end-stage renal disease (ESRD) as a justification for routine neonatal circumcision.2 Current research does not support this position.3-7

Sreenarasimhaiah and Hellerstein3 reported on 102 patients with ESRD assessed in Kansas City, Missouri, between 1986 and 1995. Urinary tract infection (UTI) was considered an important contributing factor (our italics) in only 1 patient!3

Wennerström et al4 from Goteborg, Sweden, a center that has provided decades of excellent research on UTI, recently reported a long-term prospective follow-up on 1221 children (232 boys) with a first recognized symptomatic UTI during the years 1970 and 1979. Circumcision is not common in Sweden. Only 21 boys were found to have scarring and, of these, 18 (86%) were considered to have primary or congenital scarring, rather than acquired resulting from UTI. The authors note that chronic renal failure caused by pyelonephritic renal scarring in Swedish children has decreased during the last few decades. In fact, in a population of 8.5 million, no child has been registered in this category during the last decade.4 Based on Swedish epidemiologic data, we estimate that >500 000 circumcisions are necessary to prevent end-stage renal failure in one boy.5-7

We suggest it is time to put the specter of ESRD as a consequence of failure to circumcise into the history books as an anachronism previously fed on well-intentioned speculation but less enlightened data.

WM. LANE, and M. ROBSON, MD, FRCP(C), FAAP, FRCP (Glasgow)
Pediatric Nephrology
The Children's Hospital
Greenville Hospital System
Greenville, SC 29605-4490

ROBERT S. VAN HOWE, MD
Department of Pediatrics
Marshfield Clinic--Lakeland Center
Minocqua, WI

References

  1. Schoen EJ, Colby CJ, Ray GT. External link Newborn circumcision decreases incidence and costs of urinary tract infections during the first year of life. Pediatrics. 2000; 105:789-793
  2. Wiswell TE. The prepuce, urinary tract infections, and the consequences. Pediatrics. 2000; 105:860-862
  3. Sreenarasimhaiah S, Hellerstein S. Urinary tract infections per se do not cause end-stage kidney disease. Pediatr Nephrol. 1998; 12:210-213 [Medline]
  4. Wennerström M, Hansson S, Jodal U, Stokland E. Primary and acquired renal scarring in boys and girls with urinary tract infection. J Pediatr. 2000; 136:30-34 [External link Medline]
  5. Esbjörner E, Aronson S, Berg U, Jodal U, Linne T. Children with chronic renal failure in Sweden 1978-1985. Pediatr Nephrol. 1990; 4:249-252 [External link Medline]
  6. Esbjörner E, Berg U, Hansson S. Epidemiology of chronic renal failure in children: a report from Sweden, 1986-1994. Pediatr Nephrol. 1997; 11:438-442 [External link Medline]
  7. Helin I, Winberg J. Chronic renal failure in Swedish children. Acta Paediatr (Scand). 1980; 69:607-611 [External link Medline]
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