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Antibiotic prophylaxis in antenatal nonrefluxing hydronephrosis, megaureter and ureterocele

Nature Reviews Urology volume 9, pages 321–329 (2012)Cite this article

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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.

Key Points

  • Evidence supporting the use of antibiotic prophylaxis to prevent UTI in infants with nonrefluxing upper tract dilatations or ureterocele is inconclusive

  • Reported infection rates vary widely and are comparable in patients receiving prophylaxis and those who are not

  • The prescription of antibiotic prophylaxis for UTI seems to be influenced by the local medical standards, physician experience and the likelihood of prescribing postnatal investigations

  • Antibiotic prophylaxis can be avoided in patients with low-grade hydronephrosis and no ureteral dilatation

  • Patients with high grades of hydronephrosis are at increased risk of UTI; a dilated ureter increases the risk, whereas the presence of ureterocele does not

  • Infants are most at risk in the first 6 months of life, and catheterization performed during work-up might trigger the infection

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Figure 1
Figure 2: Postnatal ultrasonograph of hydronephrosis on the transverse plane.
Figure 3: Ultrasonograph of megaureter.
Figure 4: Ultrasonograph showing a ureterocele.
Figure 5: Voiding cystourethrograph showing a ureterocele.

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Authors and Affiliations

  1. Department of Oncological and Surgical Sciences, Section of Paediatric Urology, Urology Unit, University Hospital of Padua, Monoblocco Ospedaliero, Via Giustiniani 2, 35128, Padua, Italy

    Marco Castagnetti & Waifro Rigamonti

  2. Department of Paediatric Surgery, University of Palermo, Via Alfonso Giordano 3, 90100, Palermo, Italy

    Marcello Cimador

  3. Department of Paediatrics, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy

    Ciro Esposito

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M. Castagnetti researched the data for and wrote the article. M. Castagnetti and W. Rigamonti contributed to discussions of content. All authors reviewed and edited the manuscript before submission.

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Correspondence to Marco Castagnetti.

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Castagnetti, M., Cimador, M., Esposito, C. et al. Antibiotic prophylaxis in antenatal nonrefluxing hydronephrosis, megaureter and ureterocele. Nat Rev Urol 9, 321–329 (2012). https://doi.org/10.1038/nrurol.2012.89

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