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A study published in the Canadian Medical Association Journal finds that uncircumcised boys have a higher risk of urinary tract infection (UTI) than circumcised boys, a condition that could lead to kidney damage and scarring if left untreated. The risk of infection was higher in uncircumcised boys regardless of how much of their urethral opening was visible.

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In order to determine the risks of infection for circumcised and uncircumcised boys, researchers at McGill University in Montreal looked at 393 boys who visited the emergency department of Montreal Children’s Hospital with symptoms of UTI. Of these boys, 309 were uncircumcised — the urethral opening was visible in 40 boys and partially visible or not visible in 269 — and 84 boys were circumcised.

About 20% of the boys had a UTI, and both groups of uncircumcised boys were at increased risk. Overall, researchers calculated that the risk of infection was 88% lower in the circumcised boys.

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Previous studies have suggested that uncircumcised boys have a higher risk of urinary tract infection because bacteria may build up under the foreskin and enter the urinary tract. The team wanted to see whether that higher risk held for all uncircumcised boys, even those whose urethral openings (where urine comes out) were visible. “We thought that incomplete foreskin retractability with a poorly visible urethral [opening] may be associated with increased risk of urinary tract infection,” wrote the study authors, led by Dr. Sasha Dubrovsky. “However, we found no difference in risk with degree of visibility of the urethral opening.”

The biggest concern over UTIs in children is that they can cause damage and scarring to the kidneys, according to WebMD; over time, repeated scarring can cause long-term damage, including problems with kidney function and even kidney failure — complications for which infants and young children may be at greater risk. That’s why detecting and treating UTIs in babies and children is crucial; because symptoms in such young patients may be vague, however, that’s not always easy.

“[W]e suggest that clinicians should consider circumcision status alone, not the degree of urethral visibility, when stratifying risk for boys presenting to the emergency department with symptoms or signs suggesting a urinary tract infection,” conclude the authors.

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