Open Access

PEDIATRIC UROLOGY

Canadian Pediatrics Society position statement on newborn circumcision: a risk-benefit analysis revisited

Brian J. Morris¹, Jeffrey D. Klausner², John N. Krieger³, Bradley J. Willcox⁴, Pierre D. Crouse⁵, Neil Pollock⁶

1 School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, Australia
2 Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, California, USA
3 University of Washington School of Medicine, VA Puget Sound Health Care System, Section of Urology, Seattle, Washington, USA
4 Department of Research, Kuakini Medical Center, University of Hawaii, Honolulu, Hawaii, USA
5 Intramed Medical Centre, Calgary, Alberta, Canada
6 Pollock Clinics, New Westminster and Faculty of Medicine, University of British Columbia, British Columbia, Canada
Address correspondence to Prof. Emrt Brian J. Morris, University of Sydney, Building F13, Sydney, NSW 2006, Australia

Canadian Journal of Urology 2016, 23(5), 8495-8502.

Abstract

Introduction: The Canadian Pediatrics Society (CPS) recently released a position statement on early infant (newborn) male circumcision (EIMC). It concluded that since benefits do not exceed risks, circumcision should only be performed on boys in high-risk populations or circumstances. This contradicts recommendations by the American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) whose policies each support more widespread implementation of EIMC. Here we review the CPS statement, particularly its risk-benefit analysis, to determine the basis for this disparity.
Materials and methods: We performed a risk-benefit analysis based on relevant literature retrieved from PubMed reporting frequency of each condition, giving emphasis to data from meta-analyses and randomized controlled trials.
Results: Although the CPS recognized some of the benefits of EIMC, its inclusion of weak studies of adverse events led to these being over-estimated, greatly exceeding the figure of < 0.5% found in a recent large, technically robust, CDC study. The CPS under-estimated benefits by omitting balanitis, balanoposthitis, prostate cancer, some sexually transmitted infections and candidiasis, and failing to consider lifetime prevalence of urinary tract infections in uncircumcised males. In contrast, our more inclusive risk-benefit analysis found benefits exceed risks by approximately 100 to 1 and that lack of EIMC contributes to adverse medical conditions, some potentially fatal, in approximately half of uncircumcised males.
Conclusions: The 2015 CPS position statement on EIMC is at odds with the evidence. The CPS conclusions stem from errors in its risk-benefit analysis. In light of our findings we recommend the CPS issue a revised statement.

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