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

Abstract

Widespread prenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. Antenatal hydronephrosis (AHN) and vesicoureteral reflux (VUR) are among the most common congenital anomalies diagnosed in utero or after birth. Pediatric urologists frequently rely on continuous antibiotic prophylaxis (CAP) for managing AHN, VUR, and ureterocele, unless definitive treatment is performed. The main aim of antibiotic prophylaxis (ABP) is to prevent urinary tract infection and long-term complications. Nevertheless, the efficacy of ABP has been a source of considerable debate, and pediatricians have varied opinions on who would benefit from ABP. In this review article, we searched the currently available literature, for evidence of the role of ABP in the setting of AHN, VUR, and ureterocele. Most of our studies showed a limited benefit of ABP for HN and VUR. The data on the use of CAP in the management of ureterocele is scarce. However, due to the involvement of independent risk factors and other variables, a conclusion cannot be drawn from these studies alone. Pediatric urologists are urged to conduct randomized controlled trials to compare patients followed up with and without ABP. Given the lack of guidelines, an individualized approach should be used for the use of ABP, until precise guidelines and recommendations are developed.

Ultrasound and magnetic resonance imaging features of fetal urogenital anomalies: A pictorial essay

“…The causes can also be secondary, including functional conditions such as bladder or bowel dysfunction, neurogenic bladder, and anatomic obstructions such as PUVs. 36,48 In infants with antenatal hydronephrosis (AHN), the incidence ranges from 8% to 38%. The prevalence of VUR is approximately 40%…”

“…An abnormal urine flow from the bladder into the upper urinary tract is known as VUR. The causes can also be secondary, including functional conditions such as bladder or bowel dysfunction, neurogenic bladder, and anatomic obstructions such as PUVs 36,48 …”

Microbiological profile of asymptomatic bacteriuria in pregnant women in Volta Region, Ghana

“…Other factors that influence the occurrence, progress, and outcome of ASB in pregnancy are the anatomical and physiological changes of the renal system during pregnancy (Cheung and Lafayette, 2013;Easmon et al, 1985;Oli et al, 2011). These changes include the kidneys, renal pelves, and calyces becoming larger, and ureters dilate markedly during pregnancy (right>left) which is thought to be progesterone-induced (Faiz et al, 2020). There is also increased vesicoureteral reflux and occurrence of urinary stasis or hydronephrosis in the ureters which predisposes pregnant women to asymptomatic bacteriuria to develop symptomatic pyelonephritis (Cietak and Newton, 1985;Oli et al, 2010).…”

Immunogenetic features of different forms of secondary pyelonephritis in children

“…Immunogenetic data are of great importance in differential diagnosis of SP and prognosis of the disease. However, the immunogenetic characteristics of SP have received limited attention from researchers [6][7][8].…”

“…To identify associations between different forms of COU (either complicated by chronic obstructive SP with preserved renal function, or not complicated) and immunogenetic parameters (HLA antigens), we used the relative risk (RR) formula proposed by Svejgaard and Ryder [6]:…”