Antibiotic prophylaxis in antenatal nonrefluxing hydronephrosis, megaureter and ureterocele

Abstract

Observation is a conservative management option in infants with nonrefluxing hydronephrosis, primary nonrefluxing megaureter and ureterocele diagnosed postnatally following antenatal detection of hydronephrosis. Antibiotic prophylaxis might be a sensible regimen under these circumstances to prevent UTI in this population who are potentially at increased risk. However, studies examining the efficacy of prophylactic antibiotics are sparse in this setting. For each condition, prophylactic policies seem extremely variable, and UTI rates vary widely with comparable rates reported between patients followed on and off antibiotics. Overall, antibiotic prophylaxis seems unnecessary in patients with isolated low-grade hydronephrosis. Patients with high-grade nonrefluxing hydronephrosis seem at increased risk of UTI, with risk further increasing in patients with associated ureteral dilatation (hydroureteronephrosis) irrespective of the presence of a ureterocele. Obstruction might be an additional independent risk factor, but the diagnosis of obstruction is often possible only in retrospect. The data available suggest that infants are the most at risk of UTI during the first 6 months of life, particularly if they undergo catheterization during workup examinations. Thus, antibiotic prophylaxis might be prudent during the first 6-12 months of life in patients with high-grade hydronephrosis and hydroureteronephrosis with or without ureterocele, and particularly before completion of the diagnostic workup. Paediatric urologists are urged to embark on controlled trials to compare patients followed with and without antibiotic prophylaxis.

Frequency of urinary tract infection in children with antenatal diagnosis of urinary tract dilatation

“…Our data showed that 63.2% of UTI occurred in the first 6 months of life confirming that this is the period at greatest risk, especially if they are males and affected by hydroureteronephrosis due to VUR, as suggested also by Castagnetti and colleagues 19. Frequency of VUR in our study was 5.4% of all patients with UTD, similar to that reported by Lee et al 20.…”

Prevalence of and risk factors for symptomatic urinary tract infection after endoscopic incision for the treatment of ureterocele in children

“…However, there are no convincing evidences that CAP can reduce the incidence of UTI in cases with UC after EI [24]. While further studies are necessary to clarify the effectiveness of CAP in this situation, it might be beneficial during critical period for symptomatic UTI demonstrated in the present study.…”

Role of Antibiotic Prophylaxis in the Management of Antenatal Hydronephrosis, Vesicoureteral Reflux, and Ureterocele in Infants

“…Antenatal hydronephrosis (AHN) is one of the most common anomalies detected on routine prenatal ultrasounds, affecting 1%-4.5% of all pregnancies [5]. It represents approximately 30% of all congenital defects detected on antenatal scans [6]. A variety of urological conditions can present with AHN, and differential diagnosis can usually be made only after thorough postnatal assessment [6].…”

“…It represents approximately 30% of all congenital defects detected on antenatal scans [6]. A variety of urological conditions can present with AHN, and differential diagnosis can usually be made only after thorough postnatal assessment [6]. The most common postnatal diagnoses include primary VUR in 10%-20% of cases, nonrefluxing HN (caused by ureteropelvic junction obstruction) in 10%-30% of cases, primary nonrefluxing megaureter in 5%-10% of cases, and ureterocele in 5% of cases [6].…”

“…A variety of urological conditions can present with AHN, and differential diagnosis can usually be made only after thorough postnatal assessment [6]. The most common postnatal diagnoses include primary VUR in 10%-20% of cases, nonrefluxing HN (caused by ureteropelvic junction obstruction) in 10%-30% of cases, primary nonrefluxing megaureter in 5%-10% of cases, and ureterocele in 5% of cases [6]. HN is a condition characterized by an excessive amount of urine inside the pelvicalyceal system, leading to its dilation and distension [7].…”