Jerusalem – The long-time practice by Israeli ritual circumcisers (mohelim) of using gauze for as long as 26 hours to stop penile bleeding is responsible for the significantly higher rate of urinary tract infections (UTIs) within a few weeks of the Jewish ritual.
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According to pediatricians and infectious diseases experts at Jerusalem’s Shaare Zedek Hospital, by adopting a different, yet simple medical technique for stanching the bleeding, many UTIs can be prevented. Drs. Ori Toker, Shepard Schwartz, Gershom Segal, Nadia Godovitch, Yechiel Schlesinger and David Raveh published their findings in the May issue of the Israel Medical Association Journal (IMAJ), along with an editorial by Dr. Jacob Amir, a pediatrician at Schneider Children’s Medical Center in Petah Tikva.
According to standard medical practice, a newborn infant who develops a fever must be hospitalized for observation in case the baby has developed meningitis (an inflammation of the meninges covering the brain) or other serious infection. This requires a painful spinal tap with a needle to remove a sample of cerebrospinal fluid through the baby’s back, and a few days of hospitalization until the fever subsides. This type of hospitalization is costly for the health system, and frightening and exhausting for parents.
Studies conducted abroad have showed that UTIs were infrequent when a physician performed the circumcision, even outside a hospital or clinic, compared to the rate among Israeli males circumcised by a mohel. The difference, the authors suggested, was in the method used to stop the bleeding. While mohalim wrap the penile shaft in gauze, thus raising the risk of urine retention that can lead to infection, physicians stop the bleeding by briefly applying pressure with a gloved hand, using calcium-sodium alginate fiber and adding a “wound cavity dressing” that disintegrates in two to three hours.
In his editorial, Amir urged that Israeli ritual circumcisers – supervised by a joint committee of the Health and Religious Services Ministry – be persuaded to change the way they stop the bleeding (called hemostasis in medical jargon), an aspect of brit mila that is not dictated by Jewish law. If they “adopt the hemostasis technique used by physicians – or at least shorten the duration of the shaft wrapping” – the number of UTIs and resultant hospitalizations could be minimized, he wrote. “The unique phenomenon of the high rate of UTI in male infants in Israel seems to be related to the traditional technique of hemostasis. It is time to improve the practice of traditional circumcision.” After being asked to comment, the Health Ministry told The Jerusalem Post it would seriously consider the recommendations in the journal articles and decide whether to ask the Religious Services Ministry to direct mohalim to change their hemostasis techniques.
The Shaare Zedek team studied the medical records of 449 newborns up to the age of four weeks who were brought with fever to the hospital’s pediatric emergency room between 1997 and 2006. All underwent urine cultures for UTIs, and the 290 with a positive culture had cultures taken of their cerebrospinal fluid. Their parents were asked if the infants had recently undergone circumcision and, if so, whether it had been performed by a non-physician mohel.
After eight days of life, 24.7% of circumcised boys who had fever were found to have UTIs, compared to 8.4% of girls of the same age. Meningitis was found to be very rare.
Mohalim have already changed some of their methods out of health considerations. For example, they abandoned direct sucking by mouth of the bleeding organ to avoid giving or getting hepatitis B or C, or HIV infections, and instead suck through an hourglass-shaped glass tube in which cotton wool is inserted to prevent transmission of pathogens in either direction.
mohalim do the gauze method, because other methods cause the foreskin to start grow back.
Hemostasis? That is not a way of stopping the blood.
It is a general term. Which in plain English means regulation.
A thermostat has hemostasis.
It doesn’t grow back… Everyone knows that
Same old form the Israeli seculars. Stop doing brisim, b/c OUR “studies” have proven it not healthy. Whats next? Stop blowing shofar b/c it could transmit a decease? Stop keeping sjhabbat b/c its too financially binding (thats why non of the Haraeidim have money; LOL)
I don’t know about israeli mohelim but my mohel in lakewood gave me clear signs to tell if my son(s) couldn’t urinate & directions how to re-wrap the gauze to make sure it doesn’t happen. sounds like israeli doctors want the $ from not so religious people making bris on their kids so they’re trying to scare them from using frum mohels….
#4 This advice is for AFTER the bris and is in no way against the frum – it only helps us. Stop being so paranoid
Unfortunately many mohalim in the US refuse to use sterile instruments, still do metzitza bepeh, and other unsafe practices that put the D baby M at risk F. There should be a standard that all mohalim use.
As a mohel for more than 45 years I can appreciate this article. More often than not the biggest risk to the baby comes from incompetent Mohalim. And the more frum or Chasidish the more issues I find. Minhag is not a replacment for safety and health.
Three days after the bris my son was admitted to the hospital with fever. The next 10 days were a nightmare. He underwent batteries of tests. Including spinal-tap and several x-rays, including one that they injected dyes into the bladder. In the end it was determined that he had UTI caused by a urine backup caused be restrictive bandaging. I don’t wish this on anybody. If these doctors developed a technique that can avoid this problem, why not hear them out.
These doctars want to stop milah in erertz yisroel. They make up a story abuot bleeding to make eirachla mohalim look bed. They also lie about metzitza bpeh. That is a minhag since avraham avinu. I would only do metzizah bpeeh I don’t care the risks they lie about
#8 u are totally misguided! Messisah bepeah has been for thousand of years!
I don’t see anything wrong with recommendation about bandaging after bris, while having it wrapped is clearly done it shouldn’t grow back and no one cares if u believe it will grow back or not this is what we do for thousands of years and this what is written in the seforim and we not gonna change this although there might be incompetent mohalim who don’t know how much pressure to or not to apply but in general the good mohalim know much better in than any pediatrician, here in the US when a pediatrician who practice among chareidi families will have a patient with post bris complications they will have u ask the mohel first b/c they know that they r much more experienced in their field
What a bunch of bogus you people write. most if not all frum mohelim are competent well trained experts that have more experience in this area then most Drs. besides for any other reason its logical, every frum boy has a bris and every new parent knows someone that has had boy befor and used a mohel. A mohel that uses unsterilized equipment how long doyou think would be in business for. #10 I’m calling your bluff what’s your name?
This is nonsense. My husband is a mohel for 28 years and he always uses gauze and has Baruch Hashem, bli ayin hara, never had a problem with any of the children he did brisim for. When one does a mitzva, no harm comes from that. A urinary tract infection could develop because of the way the baby is bathed or other factors….nothing to do with the gauze!
“For thousands of years” doctors went straight from the morgue to the operating room without washing their ungloved hands. People believed demons caused disease. Nobody knew that the heart pumped blood. Patients were bled to balance the four humors. Childbed, cholera and smallpox killed millions. Anyone bitten by a rabid animal died in unspeakable agony. People died of pain and shock under the knife because there was no anesthesia.
Medical science has advanced since then. If we can save little boys’ lives by taking advantage of advances in medicine we should do so.
These doctars want to stop milah in erertz yisroel. They make up a story abuot bleeding to make eirachla mohalim look bed. They also lie about metzitza bpeh. That is a minhag since avraham avinu. I would only do metzizah bpeeh I don’t care the risks they lie about
The Dr’s. use clamps, so they can stop the bleeding without pressure. Besides the hospitals encourage the mothers to take pain-killers (how’s your pain from 1-10?) and that causes allot of bleeding problems. At the Bris I can detect if the mother is on pain-killrs. I used to not even have to bandage, I controlled the bleeding with plain “talc”. But since they started with pain-killers (blood-thinners) pressure bandages are necessary, if you don’t use a clamp. By the way I seldom hear of a baby that had a urinary infection after the Bris. I check the baby 1-2 weeks after the Bris.
I had several brisim made on mey children. Im chasidish, the mohel did metizah bpeh and did a very good job post bris. 3 hours afer the bris he came to the babys house and check the guse to make sure that the baby is able to urinate he told me it has to be cheked and made sure that he urinates with it because if not it can cuse an infection and it a big sackana besides of all this. I live in the US and guys just whatch out who you take for a mohel there are reposnsebale mohalem and there are iresposible.
to all who never wants to change a minhag I have news for you
The blood sucking is a thing that the Talmud itself says should be done for medical reasons, and that was clearly what a doctor would have said in that time period.
I have no doubt that the Talmud would say now, if you suck you are endangering you kid. I made a mistake years ago I am sorry but I was following doctors orders.
They had brains then, and would be horrified how many use their writing to harms today children. and maybe even ask are they Jews?
Not all brissim will ever be done in the hospital by physicians. Many Mohels have some competence in the best medical procedures. Once and for all there should be strict licensing requirements and continuing education requirements for all Mohels. Otherwise, we risk have brissim outlawed unless done by medical experts.
Dr Jacob Amir has republished this same article at least six times in the last 24 years. In fact in the article found here: http://www.ima.org.il/imaj/ar10may-13.pdf
he cites himself 3 times, including his original 1986. In short, in methodology is quite dishonest. Example: If Mohelim account for 75% of infections and doctors account 25% infections who has a better success rate?
A: Doctors? Wrong! It depends. If Drs and mohelim each perform an equal amount of brissim, the Doctors have a better success rate. If however, mohelim circumcise 3 babies for every bris done by a doctor, the rate is equal, and if mohelim do 100 babies for one done by a Dr, the doctors are 33 times worse than the mohelim. This ratio is not discussed. Dr. Amir’s 24 year history of dishonesty can be viewed by searching Pubmed.gov “Amir J[au]circumcision” and reading his articles.
In fact other authors write the exact opposite:
Complications of Circumcision in Israel: A One Year Multicenter Survey. Ben Chaim J, Livne PM, etal. IMAJ 2005. 7(6):368-70. A total of 0.34 complications (66 out of 19,478) of which 0.01 were infections. Pubmed 15984378
In fact, the success rate for circumcision is so good that other surgeons have asked:
Are sterile conditions essential for all forms of cutaneous surgery? The case of ritual neonatal circumcision. Naimer SA, Trattner A. Journal: J Cutan Med Surg. 2000. 4(4):177-80 Pubmed 11231194
In general infant circumcision minimizes UTIs.
Cohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection. To T, Agha M, Dick PT, Feldman W. Lancet 1998. 352(9143):1813-6
Regarding Metzitzah, it’s interesting to note, that since the NYS Circumcision Protocols requiring testing of the parents went into effect, there hasn’t been even a single suggested case of neonatal herpes due to metzitzah.
Correct me if I am wrong, but I have no idea where in chazal there is any mention of using surgical gauze to bandage after a bris miloh! Shaarei Tzedek is a frum hospital, where everything is done with the approval of Rav Osher Weiss Shlit”a who is their posek. A very high proportion of their doctors are frum, ehrliche yidden. All they are trying to do is to improve the healing process after the bris. Many medical procedures are altered and updated on the basis of new reserach, even procedures which have been used for many years. I stress again: surgical gauze as a bandage is NOT an ancient tradition. You may as well insist we still use cloth diapers for a bris (I remember mohalim 20 years ago who did).