Investigation and management of antenatally detected hydronephrosis

Abstract

All ANH should be investigated with a post-natal RUS.2 Level 1 Evidence: Grade A Recommendation The role of prophylactic antibiotics initiated at birth is controversial. Grade D Recommendation The need to further investigate mild postnatal hydronephrosis (SFU 0–II) with a VCUG is controversial, and depends on the physician’s attitude toward diagnosing asymptomatic VUR. Grade D Recommendation The need to reassess mild postnatal hydronephrosis with a second RUS is unclear, but does provide reassurance to the physician and parent if the ANH remains stable or improves. Level 4 Evidence: Grade C Recommendation Persistent moderate or severe hydronephrosis (SFU III–IV) should be investigated with a VCUG, followed by diuretic renography if the hydronephrosis cannot be explained by VUR.1 Level 4 Evidence: Grade C Recommendation A summary flow chart is provided (Fig. 1). To assist in the decision-making of controversial areas, members of the Pediatric Urologists of Canada were surveyed in 2007 to determine most common practice patterns. The results, based on the responses of 15 Canadian members, are included in the flow chart. Fig 1 Summary flow chart of Levels of Evidence and Grade recommendations for evaluating antenatal hydronephrosis. *93% would not order a voiding cystourethrogram (VCUG) if Society of Fetal Urology (SFU) 0; 80% would not order a VCUG for SFU I; 73% would order ... Footnotes This article has been peer reviewed. Competing interests: None declared.