Society for Fetal Urology Recommendations for Postnatal Evaluation of Prenatal Hydronephrosis—Will Fewer Voiding Cystourethrograms Lead to More Urinary Tract Infections?

Abstract

With adherence to our protocol, voiding cystourethrogram was avoided in almost half of evaluated infants. No infant diagnosed with vesicoureteral reflux had a urinary tract infection. Catheterization was associated with a urinary tract infection in 50% of cases. An anteroposterior diameter of 9 mm or greater and a SFU grade of 3 or greater were associated with postnatal progression to surgery. Patients with a SFU grade of 4 progressed to surgical intervention at a faster rate than those with a grade of greater than 3.

Prenatally detected, unilateral, high-grade hydronephrosis: Can we predict the natural history?

“…Patients with an SFU grade of 4 progressed to intervention at the fastest rate. 18 Kim and associates concluded that an APD cutoff of 5, 8, and 10 mm during the second, early third, and late third trimesters, respectively, is more specific in predicting the need for postnatal surgical intervention in the Korean population.…”

Pediatric congenital hydronephrosis (ureteropelvic junction obstruction): Medical management guide

“…Many reports show that the risk of kidney damage is low for an APD <2 mm, and that the rate of surgical intervention increases in patients with APD >20-30 mm or SFU grade ≥3. 32,[55][56][57] In patients with an APD >40-50 mm, early pyeloplasty is often carried out. In patients with grade 4 HN, follow up is carried out every 1-3 months, and further evaluation by DR is carried out.…”

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

“…VCUG should be carried out in all patients with bilateral grade 2–4 and unilateral grade 3–4 hydronephrosis . According to the SFU, 3‐year follow up of children with PNH showed that 60% underwent VCUG and 13% had VUR, of whom 4% underwent UCN . VCUG should be reserved for patients who have UTI, dilated ureters and voiding symptoms with ureteral abnormalities …”

“…24 According to the SFU, 3-year follow up of children with PNH showed that 60% underwent VCUG and 13% had VUR, of whom 4% underwent UCN. 25 VCUG should be reserved for patients who have UTI, dilated ureters and voiding symptoms with ureteral abnormalities. 26 VCUG is invasive for patients and distressing for parents VCUG is painful and unpleasant, with urethral catheterization and voluntary voiding in public.…”