The efficacy of prophylactic antibiotics in preventing UTIs or renal damage in patients with antenatal hydronephrosis, with or without VUR, is difficult to determine because of variability in methods and results [39]. In addition, most of the VUR spontaneously resolves [40]. One of the potential risks of VCUG is iatrogenic UTI. This was reported in about 2% of VCUG studies performed for evaluation of antenatal hydronephrosis [39]. Voiding Urosonography Multiple recent investigations evaluating real-time contrast-enhanced US techniques have demonstrated a high degree of diagnostic accuracy, and some demonstrated increased sensitivity as compared to fluoroscopic VCUG in the detection of VUR [41-45]. The main potential disadvantage of voiding urosonography is a lower anatomical detail of the bladder and urethra, and therefore it should not be used as the first study for male patients. Therefore, arguments for and against using voiding urosonography are similar to that of VCUG with the exception of male patients. Nuclear Medicine Cystography Some studies have suggested equal sensitivity for Tc-99m pertechnetate radionuclide cystography and VCUG [46], whereas others have indicated that radionuclide cystography has improved sensitivity for VUR in infants up to 1 year of age [47]. The main disadvantage of radionuclide cystography is that it does not provide anatomical details of the bladder and urethra and therefore should not be used as the first study for male patients. Therefore, arguments for and against using radionuclide cystography are similar to that of VCUG with the exception of male patients. DTPA Renal Scan There is no relevant literature to support the routine use of Tc-99m diethylenetriamine pentaacetic acid (DTPA) renal scan in the initial postnatal evaluation of antenatal hydronephrosis.
Antenatal Hydronephrosis Infant. The efficacy of prophylactic antibiotics in preventing UTIs or renal damage in patients with antenatal hydronephrosis, with or without VUR, is difficult to determine because of variability in methods and results [39]. In addition, most of the VUR spontaneously resolves [40]. One of the potential risks of VCUG is iatrogenic UTI. This was reported in about 2% of VCUG studies performed for evaluation of antenatal hydronephrosis [39]. Voiding Urosonography Multiple recent investigations evaluating real-time contrast-enhanced US techniques have demonstrated a high degree of diagnostic accuracy, and some demonstrated increased sensitivity as compared to fluoroscopic VCUG in the detection of VUR [41-45]. The main potential disadvantage of voiding urosonography is a lower anatomical detail of the bladder and urethra, and therefore it should not be used as the first study for male patients. Therefore, arguments for and against using voiding urosonography are similar to that of VCUG with the exception of male patients. Nuclear Medicine Cystography Some studies have suggested equal sensitivity for Tc-99m pertechnetate radionuclide cystography and VCUG [46], whereas others have indicated that radionuclide cystography has improved sensitivity for VUR in infants up to 1 year of age [47]. The main disadvantage of radionuclide cystography is that it does not provide anatomical details of the bladder and urethra and therefore should not be used as the first study for male patients. Therefore, arguments for and against using radionuclide cystography are similar to that of VCUG with the exception of male patients. DTPA Renal Scan There is no relevant literature to support the routine use of Tc-99m diethylenetriamine pentaacetic acid (DTPA) renal scan in the initial postnatal evaluation of antenatal hydronephrosis.