OR Discussion of Procedures by Variant Variant 1: Antenatal diagnosis of hydronephrosis. Initial neonatal imaging. US Kidneys and Bladder Retroperitoneal US in the immediate postnatal period evaluates for the presence and severity of underlying urologic abnormalities and therefore has a role in guiding management [3,6,12,19-25]. Because of the relative low urine production in newborns, initial imaging should be delayed at least 48 to 72 hours after birth [3,26-29]. Exceptions include newborns with severe, bilateral hydronephrosis and bladder abnormalities, oligohydramnios, or situations in which follow-up studies may be difficult to obtain. In these infants, earlier imaging is indicated [20,27,29,30]. Fluoroscopic Voiding Cystourethrography There is controversy regarding whether all children with antenatal hydronephrosis should undergo voiding cystourethrography (VCUG). A meta-analysis by the American Urology Association found that, on average, approximately 16% of neonates and infants with antenatal hydronephrosis will have VUR. The incidence of VUR was independent of degree of antenatal hydronephrosis, and a quarter of these were found to have no hydronephrosis on postnatal US [31]. There is disagreement over whether this VUR is clinically significant and therefore over the need for diagnosis. Some authors advocate VCUG for all infants with antenatal hydronephrosis, to guide treatment with prophylactic antibiotics [20,27,32,33]. However, currently, most authors (including the 2010 SFU consensus statement) recommend against routine VCUG for antenatal hydronephrosis [2,12,29,34,35]. This is largely because the benefit of prophylactic antibiotics in children with urinary tract infection (UTI) has not been clearly demonstrated and remains controversial. Some studies have suggested that prophylactic antibiotics may be beneficial in patients with VUR [36-38].
Antenatal Hydronephrosis Infant. OR Discussion of Procedures by Variant Variant 1: Antenatal diagnosis of hydronephrosis. Initial neonatal imaging. US Kidneys and Bladder Retroperitoneal US in the immediate postnatal period evaluates for the presence and severity of underlying urologic abnormalities and therefore has a role in guiding management [3,6,12,19-25]. Because of the relative low urine production in newborns, initial imaging should be delayed at least 48 to 72 hours after birth [3,26-29]. Exceptions include newborns with severe, bilateral hydronephrosis and bladder abnormalities, oligohydramnios, or situations in which follow-up studies may be difficult to obtain. In these infants, earlier imaging is indicated [20,27,29,30]. Fluoroscopic Voiding Cystourethrography There is controversy regarding whether all children with antenatal hydronephrosis should undergo voiding cystourethrography (VCUG). A meta-analysis by the American Urology Association found that, on average, approximately 16% of neonates and infants with antenatal hydronephrosis will have VUR. The incidence of VUR was independent of degree of antenatal hydronephrosis, and a quarter of these were found to have no hydronephrosis on postnatal US [31]. There is disagreement over whether this VUR is clinically significant and therefore over the need for diagnosis. Some authors advocate VCUG for all infants with antenatal hydronephrosis, to guide treatment with prophylactic antibiotics [20,27,32,33]. However, currently, most authors (including the 2010 SFU consensus statement) recommend against routine VCUG for antenatal hydronephrosis [2,12,29,34,35]. This is largely because the benefit of prophylactic antibiotics in children with urinary tract infection (UTI) has not been clearly demonstrated and remains controversial. Some studies have suggested that prophylactic antibiotics may be beneficial in patients with VUR [36-38].