Sir.—In the March 1989 issue of AJDC, Herzog1 presented reports of 36 infants with positive urine culture during routine workup for acute illness. All these infants were uncircumcised, whereas this was true only for 32% of the control population. Of the 31 infants who underwent roentgenographic studies, 4 had grade II and 2 grade IV reflux, 1 had posterior urethral valve with hydronephrosis, and 1 had ureteropelvic junction obstruction and hydronephrosis. The authors concluded that noncircumcision is a highly significant risk factor for UTI in infants.
There is a recent surge of interest and controversy about the association of infantile UTI and periurethral bacterial flora with noncircumcision.2-14 On one side of the spectrum circumcision is considered to be a prophylactic measure against UTI in infants (Wiswell and his collaborators3,8,10,13,14), while on the other, the need to perform surgery on 96 to 98 infants to prevent two to