Table 1

A comprehensive risk-benefit analysis of infant MC

    Risks from not circumcising

    Condition

    Level of evidence
*

    Fold increase

    NNT


Urinary tract infection (infants)

1++

10

50

Urinary tract infections (lifetime)

2+

5

4

Pyelonephritis (infants)

2+

10

100

- with concurrent bacteraemia

2+

200

1000

- childhood hypertension

2

-

1500

- end-stage renal disease (lifetime)

2+

-

500

Candidiasis

2

2

10

Prostate cancer

2

1.5-2

6

Balanitis

2++

3

10

Phimosis

1++

infinite

10

High-risk HPV

1++

3

2

Genital herpes (HSV-2)

1+

1.35

Syphilis

1+

3

200

HIV infection

1++

3-8

1000

Penile cancer

1++

> 20

1000

In female partner:

Cervical cancer

1++

4

-

Chlamydia

2+

4

-

HSV-2

2+

2

-

Bacterial vaginosis

1+

2

-

Thus risk in an uncircumcised male of developing a condition requiring medical attention over their lifetime = 1 in 2

    Risk associated with medical MC in infancy

    Condition

    Fold increase

    NNH
††

Local bruising at site of injection of local anesthetic (if dorsal penile nerve block used)

0.25*

4

Infection, local

0.002

600

Infection, systemic

0.0002

4000

Excessive bleeding

0.001

1000

Need for repeat surgery (if skin bridges or too little prepuce removed)

0.001

1000

Loss of penis

close to 0

1 million

Death

close to 0

Over 1 million

Loss of penile sensitivity

Low

High

Thus risk of an easily-treatable condition = 1 in 500 and of a true complication = 1 in 5000


*As per Scottish Intercollegiate Guidelines Network (SIGN) grading system for evidence-based guidelines [87], which ranges from 1++ (highest) to 4 (lowest).

Values shown are based on statistics for USA (for source data see review [18] and references cited in the present article)

Abbreviations:

NNT number needed to treat - i.e., approximate number of males who need to be circumcised to prevent one case of each condition associated with lack of circumcision.

††NNH number needed to harm, i.e., approximate number of males that need to be circumcised to see one of each particular (mostly minor) adverse effect. *The minor bruising (from this method only) disappears naturally without any need for medical intervention, so is not included in overall calculation of easily-treatable risks

Morris et al. BMC Pediatrics 2012 12:20   doi:10.1186/1471-2431-12-20

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