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The prepuce: a mistake of nature?
J Winberg1, I Bollgren, L Gothefors
1Department of Paediatrics, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden.
Lancet (London, England)
|March 18, 1989
Summary
Newborn male circumcision may prevent 90% of early infantile urinary tract infections (UTIs). This may be due to counterbalancing unphysiological interventions, with alternatives like promoting natural gut flora colonization.
Area of Science:
- Pediatric infectious diseases
- Evolutionary biology
- Microbiome research
Background:
- Retrospective studies indicate male circumcision reduces early infantile urinary tract infection (UTI) by approximately 90%.
- This potential prevention of a common, lethal disease by tissue removal is biologically unusual.
- A hypothesis suggests circumcision counteracts unphysiological bacterial colonization (e.g., non-maternal *Escherichia coli*) in newborns, to which they lack passive immunity.
Purpose of the Study:
- To explore the biological and evolutionary mechanisms potentially explaining the high efficacy of circumcision in preventing male infantile UTIs.
- To propose alternative, less invasive strategies for preventing early infantile UTIs.
Main Methods:
- Review and synthesis of existing retrospective study data on circumcision and UTI rates.
- Theoretical reconciliation of observed phenomena with evolutionary and biological principles.
- Proposal of alternative preventative strategies based on microbial colonization.
Main Results:
- Circumcision's protective effect against UTI is hypothesized to result from counteracting harmful bacterial colonization.
- The unphysiological colonization may stem from hospital environments, leading to infections in infants lacking maternal immunity.
- Alternative strategies focus on promoting natural, protective microbial colonization.
Conclusions:
- The effectiveness of circumcision in preventing male infantile UTIs may be an indirect effect of counteracting specific bacterial colonization patterns.
- Promoting natural maternal-infant microbial exchange (e.g., rooming-in, active colonization with maternal flora) is suggested as an alternative UTI prevention method.