# 18 Month Old Boy Uncircumcised First Uti



## JENNY BRAUN (Aug 21, 2008)

my 18 month old has recently had his first uti he is not circumcised and they want me to circumcise him and put him through that vcug where they shoot dye into his kidneys to check for reflux. my gut says this is a drastic reaction to his first uti but i dont want to waiver a procedure they think is necessary. The week he got the uti it was hot, humid and nasty out and hes wears cloth diapers (which i have switched to disposable for now) he has had about 3 or 4 infections on the tip of his penis also two happened after swimming in a public pool---I think the chlorine wipes away the good bacteria. Anyways any comments????


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## MCatLvrMom2A&X (Nov 18, 2004)

The Dr's are over reacting in a huge way. They are not up to date at all on the research showing being intact has nothing to do with UTI's ask them what they would want to cut off if he was a girl







: The only thing cutting his foreskin off will do is make him more prone to problems not fix anything.

Here are some links.
UTI myth http://www.cirp.org/library/disease/UTI/
http://www.nocirc.org/statements/breastfeeding.php

Quote:

In fact, UTI's are so rare in any case that, using Wiswell's data, 50 to 100 healthy boys would have to be circumcised in order to prevent a UTI from developing in only one patient. (Using more recent data from a better-controlled study, the number of unnecessary operations needed to prevent one hospital admission for UTI would jump to 195.
FORESKINS: Seek Elsewhere for Infants' Urinary Tract Infections
http://www.cirp.org/news/1997.12.22_PhysiciansWeekly/

UTI Neonatal circumcision revisited
http://www.cps.ca/english/statements...ION%20OF%20UTI

The incidence of Geniturinary abnormalities in circumcised and uncircumcised presenting with an initial urinary tract infection by 6 months of age
http://www.cirp.org/library/disease/UTI/mueller/
- Girls have a much greater risk of UTIs, yet we don't cut off parts of their genitals to prevent them.

IMHO as well 1 UTI is not enough to warrent the invasive VCUG test. I would wait on that 1 to see if he has another before concenting.

Here is another thread you may find helpfull since you mentioned possible infections they were probably just seperation issues or irritation from the pool not true infections http://www.mothering.com/discussions...d.php?t=764732

ETA if you do decide to have the VCUG or any Dr. wants to look at his penis make 100% sure they do not retract him ie push back any on the foreskin. These links are helpful as well A Warning to Parents of Intact Sons & The definition of Retraction & why it is BAD


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## MommytoB (Jan 18, 2006)

Hey one uti should just only require antibiotics if it happens at least 3 more times then you do the dye stuff along with a u/s of the urinary tract system, make sure he's getting fluids and how did they find out about the Uti ? Are you retracting the foreskin if so 'then stop right now!!!!!!!

How did you know that the other's were infection were they just 'red at top any white cottage cheese discharge with some yellow or dab of red in it ? Did the doctor do any 'culture at the tip of the foreskin ?

If your son had a cottage cheese discharge with any above more likely it was seperation trauma but if a doctor gives antibiotics for what is not a problem he can create a problem by creating yeast issues caused by antibiotics-treament monistat /vagisil otc cream,

Do not use neosporin that has neomycin and can cause alot of issues especially in the penis area!


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## Fellow Traveler (Jan 8, 2008)

I agree vcug sounds like a drastic first step. Start with ABX and then go from there. These infections you speak could easily come from the pool and or just plain diaper rash. Follow the advice you got from the previous posters and if you want to speak to someone directly, you could always give NOCIRC a call too. One more thing, the vcug is being used to look for a congenital anomaly of the urinary track. If they find it, that is what causes UTIs not a foreskin. Let me know if you want contact info from NOCIRC someone can PM it to you. Please keep us posted, we'll get you and your son through this.


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## foreskin friendly (Jul 16, 2007)

when I spoke with John Geisheker about my son, he said he gets overwhelmed with calls from parents about your situation exactly.
Mostly, it is a seasonal thing as the kids are in the pool and that causes irritations/infections...
Call D.O.C. and they can direct you to a foreskin friendly doc who WILL NOT suggest cutting off bits of your son's body b/c of an infection that can easily be treated with ABX..

NOONE SHOULD be retracting his foreskin AT ALL... not for a urine sample, not to 'check" anything....nothing at all is cause for retraction... if this was occurring, this could be the cause of his previous irritations/redness...

good luck and give D.O.C. a call.. they are all very kind and informative group of fellows!!!


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## 2boyzmama (Jun 4, 2007)

Of course circumcision is not necessary, that part of their recommendations is just ridiculous.

As far as the VCUG...my youngest son had a UTI at 9 weeks old, and we did do the VCUG. I researched...UTIs are so rare at that age, circ'd or not, that his chances of having urinary reflux were greater, and the damage that could be done to his ureters or kidneys was significant. It is probably appropriate for a little girl to wait until she's had several UTIs, but for a little boy, it may be appropriate after only 1 or 2. But, if you have a suspicion on what caused the UTI (like you said it was hot and muggy, maybe he's been playing with himself more lately and had dirty hands...what toddler doesn't!, maybe he's been taking some bubble baths, etc etc) then you can probably wait.

Did they take a sterile cath sample to determine he had a UTI? Having a toddler pee in a cup will not likely give an accurate result, nor will a baggie. I always use the baggie as a screen of sorts...if the test is negative with the baggie, then it's negative. If it's positive, then follow up with a cath to confirm that it's positive. Otherwise you may end up with abx unnecessarily. If they did confirm the UTI with a cath sample, you will want to do another cath after the abx are finished to ensure the infection is truly gone.

A VCUG is no more invasive than a cath, they do fill the bladder with a dye and take a few xrays to check to see if the dye is backflowing up into the ureters. They will check for structural defects that may have caused an infection. A VCUG can be done on an intact boy just as easily as a cath can, you just need to make sure the nurse who does the test is educated on how to catch an intact boy. The test is not painful, but does require some restraint for the xrays.

Again, it probably isn't necessary for a first UTI when you have some suspicion of what caused it (in our case, he was only 9 weeks old with some known special needs and a lot of unknown medical issues, so doing the test after only one UTI was the prudent thing to do. As it turns out, he has a genetic syndrome which is known to effect kidney function, so although the VCUG was normal, once we discovered his genetic syndrome, we would have had to do one to rule out abnormal kidneys anyway, it was one test we had out of the way already).


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## TCA2008 (Nov 20, 2007)

well, I agreed to a VCUG on my 3 month old because of 1 UTI, and in retrospect, I wish I hadn't. It was so invasive and traumatic. My son actually did get diagnosed with reflux, and then the standard recommendation is daily antibiotics possibly for years.

In the end, I refused the antibiotics and refused all follow up VCUGs, my son never had another UTI and he is 7 years old now. The urologist was not happy about it, but my primary care physician is very open to alternatives, and I just made a plan with her that we would watch for signs of infection - fever, etc...and if chronic UTIs became a problem, THEN we would consider prophalactic antibiotics or more VCUGs, etc...but as long as he just had 1 or 2 UTIs a year, then we'd just treat those episodes. That was our plan and she was fine with it.

If I were in the same situation now and my baby or toddler (or older child) developed a single UTI, I'd just treat that episode with antibiotics. If a chronic problem developed, like 3-4 UTIs in a couple of months, then I'd be concerned that something is going on and I would agree to more invasive tests and treatments. But for just one UTI, I would not put my child through that experience - they have to be strapped down, catheterized, it is very painful and uncomfortable.

Perhaps you could make an agreement with your doctor that you'd like to do the "wait and see" approach and watch your child vigilantly for any signs of future UTIs, and that if he developes more in the next few months, then you can consider more invasive procedures, but if he remains UTI free, you'll just leave the issue alone.


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## JENNY BRAUN (Aug 21, 2008)

what is a abx?


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## JENNY BRAUN (Aug 21, 2008)

he has not been retracted they told me just to pull it back so you could see the opening to wipe but not to retract


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## JENNY BRAUN (Aug 21, 2008)

what should i bathe him in just aveeno body and bath wash??


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## TattooedMama (Aug 31, 2005)

Quote:


Originally Posted by *JENNY BRAUN* 
he has not been retracted they told me just to pull it back so you could see the opening to wipe but not to retract

That is retracting.


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## TattooedMama (Aug 31, 2005)

Quote:


Originally Posted by *JENNY BRAUN* 
what should i bathe him in just aveeno body and bath wash??

If the tip of his foreskin is red I would be bathing with plain water. Not using body washes.


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## Fellow Traveler (Jan 8, 2008)

Quote:


Originally Posted by *JENNY BRAUN* 
what is a abx?

Sorry about that, Antibiotics.


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## MCatLvrMom2A&X (Nov 18, 2004)

Quote:


Originally Posted by *JENNY BRAUN* 
he has not been retracted they told me just to pull it back so you could see the opening to wipe but not to retract

Like pp said that is indeed retracting and is a big









Please read the links in my pp about retraction and the warning one.


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## Baby Makes 4 (Feb 18, 2005)

Here is my experience with the same problem but at a much younger age:

My DS got a bad UTI when he was 4 months old. By the time he was admitted to the hospital he had a fever of 105, he was a very sick little boy. They put a urine catch bag on him and found that the bacteria was a nasty drug-resistant strain so he spent a week in the hospital on IV antibiotics.

He had an ultrasound of his kidneys that showed a mild reflux. The Ped Urologist wanted to do the dye test and I said they could do it as long as they sedated him and did not retract his foreskin to insert the catheter. We showed up on the day of the test and they had decided not to sedate him and the nurse said that retraction may be necessary so we took him home. A follow up ultrasound done 6 months after the first one showed that the reflux had resolved itself and he has not had one infection since then.

Because of the reflux we were required to bag him and send off a urine sample any time he ran a fever over 100 but nothing ever came back positive for an infection again.

I am in Canada and nobody ever suggested circumcision as a solution. In fact, no doctor has ever said the word to me at all, it's never come up.


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## Fellow Traveler (Jan 8, 2008)

Hope your little guy is doing better.









Quote:


Originally Posted by *JENNY BRAUN* 
he has not been retracted they told me just to pull it back so you could see the opening to wipe but not to retract

This isn't really necessary. The rule of thumb is to just clean what you see. A little wipe like a finger should be all you need. As he gets a bit older 5 or 6 you can start to encourage him to pull it back as much as he can but only he should do this and you should know that even then he may not be fully retractable. Only about 50% are fully retractable by 11. Here is some more info on that:

http://www.cirp.org/library/normal/

http://www.cirp.org/library/hygiene/

Quote:


Originally Posted by *JENNY BRAUN* 
what should i bathe him in just aveeno body and bath wash??

As far as your UTI goes, how was that diagnosed? I presume a urine sample? In any case some time the tip of the foreskin can get red for a few reasons. First it might be that the foreskin has begun the process of separating from the glans. In some boys there is mild discomfort/redish tip looking foreskin. We have a good thread about that which I'll bump for you. Second, if could be the pool to. He may be sensitive to the chlorine or they may use too much. Third, (along the lines of chemical), any soaps such as detergents in clothes or bath might also irritate him. These kind of things are a bit rare and I don't think it is that. You also said you use cloth diapers, I know that sometimes these have to be 'stripped' hopefully someone can post info on that since I don't know anything about it.

If it was truly a UTI, diagnosed properly and such, I would just follow the antibiotic script you got to the end and wait and see. Did the doctor give you any specific reason why he wanted to move right to vocg?


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## JENNY BRAUN (Aug 21, 2008)

they just said it was a necessary step to rule out reflux and there was no other way to determine if thats what it was. they keep saying "permanent kidney damage " to scare me into doing it I think. My pediatrician is a good person she doesn't give me a hard time about breastfeeding or not vaccinating I just think she has been educated one way and thats all she can tell me.


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## JENNY BRAUN (Aug 21, 2008)

Yeah I realize that now-I think this may be why he had the other infections on the tip of his penis. thats why this bothers me so much I've been given false instructions on how to care for his penis and now they are acting as if his has defect that needs correcting!!


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## Yulia_R (Jan 7, 2006)

Quote:


Originally Posted by *foreskin friendly* 
NOONE SHOULD be retracting his foreskin AT ALL... not for a urine sample, not to 'check" anything....nothing at all is cause for retraction... if this was occurring, this could be the cause of his previous irritations/redness...









:

Have you read these two VERY important threads:

*A Warning For Parents of Intact Sons* http://www.mothering.com/discussions...d.php?t=129378

and

*The Definition of "Retraction" & Why it is BAD*
http://www.mothering.com/discussions...d.php?t=575627

If I were you, I'd run from this doctor as fast as I could and find a foreskin friendly doctor.


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## Fellow Traveler (Jan 8, 2008)

Quote:


Originally Posted by *JENNY BRAUN* 
they just said it was a necessary step to rule out reflux and there was no other way to determine if thats what it was. they keep saying "permanent kidney damage " to scare me into doing it I think. My pediatrician is a good person she doesn't give me a hard time about breastfeeding or not vaccinating I just think she has been educated one way and thats all she can tell me.

Well, whether or not you do the Vocg is up to you. I don't personally know much about the procedure other than that is how they check for this abnormality. I will say this though, circumcision will not help whether or not he has that. Perhaps you could phone DOC or NOCIRC and get a reference to someone who is foreskin friendly for a second opinion.

ETA: I was just wondering since a work up like that occurs after more than one perhaps two or three UTIs not after often after the first. I was just courious if there was something more they saw, said or noticed.


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## JENNY BRAUN (Aug 21, 2008)

I Dont Think So... My Ped Just Said For A Baby It Was Necessary To Do A Vcug To Check For Reflux Because Boys Get It So Rarely. But I Think It Must Just Be Standard Procedure Unfortunately Because My 14 Month Old Niece Got One A Week Prior To This After Just Her First Uti!!


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## onlyboys (Feb 12, 2004)

Jenny, I think you may need to find a foreskin friendly doctor. Perhaps you could get a second opinion with one who knows foreskins or (gasp!) actually HAS one!

If this were my son, I would stop the retraction immediately, treat the UTI with antibiotics, change doctors and make sure no one retracts my son even just a bit.

Good luck, I know it's hard to go up against a ped who thinks that intervention like circumcision is necessary.


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## Yulia_R (Jan 7, 2006)

Quote:


Originally Posted by *onlyboys* 
Jenny, I think you may need to find a foreskin friendly doctor. Perhaps you could get a second opinion with one who knows foreskins or (gasp!) actually HAS one!

If this were my son, I would stop the retraction immediately, treat the UTI with antibiotics, change doctors and make sure no one retracts my son even just a bit.

100% agree.


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## loveyourohana (Jul 14, 2008)

I think your pediatrician is off the rocker!!! I don't see any reason for the procedure they are suggesting... This is his first Uti.

If I were you, I would find another Dr. To be completely honest, I use an N.D or an M.D., N.D because they will use naturaly means before invasive procedures


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## shelbean91 (May 11, 2002)

My dd had either 2 or 3 uti's by the time she was 18 mos. No one suggested circing her, but they did suggest the vcug if she got another one. She's now 8 and hasn't had one since.


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