PD15-10 PRENATAL HYDRONEPHROSIS WITH URETERAL DILATION SEVEN MILLIMETERS OR GREATER IDENTIFIES PATIENTS AT INCREASED RISK OF URINARY TRACT INFECTION

Abstract

You have accessJournal of UrologyPediatric Urology I (PD15)1 Sep 2021PD15-10 PRENATAL HYDRONEPHROSIS WITH URETERAL DILATION SEVEN MILLIMETERS OR GREATER IDENTIFIES PATIENTS AT INCREASED RISK OF URINARY TRACT INFECTION Sarah Holzman, Rebecca Zee, Luis Braga, C. D. Anthony Herndon, Carol Davis-Dao, Nora Kern, Joshua Chamberlin, Melissa McGrath, Kai-wen Chuang, Heidi Stephany, Elias Wehbi, Anne Dudley, Valre Welch, Gina Lockwood, Jennika Finup, and Antoine Khoury Sarah HolzmanSarah Holzman More articles by this author , Rebecca ZeeRebecca Zee More articles by this author , Luis BragaLuis Braga More articles by this author , C. D. Anthony HerndonC. D. Anthony Herndon More articles by this author , Carol Davis-DaoCarol Davis-Dao More articles by this author , Nora KernNora Kern More articles by this author , Joshua ChamberlinJoshua Chamberlin More articles by this author , Melissa McGrathMelissa McGrath More articles by this author , Kai-wen ChuangKai-wen Chuang More articles by this author , Heidi StephanyHeidi Stephany More articles by this author , Elias WehbiElias Wehbi More articles by this author , Anne DudleyAnne Dudley More articles by this author , Valre WelchValre Welch More articles by this author , Gina LockwoodGina Lockwood More articles by this author , Jennika FinupJennika Finup More articles by this author , and Antoine KhouryAntoine Khoury More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001997.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prenatal hydronephrosis with concomitant hydroureter is an established risk factor for urinary tract infection (UTI); however, the minimum ureteral diameter for hydroureter is not well defined. We evaluated the definition of clinically significant hydroureter, its association with UTI and whether continuous antibiotic prophylaxis (CAP) impacted UTI risk. METHODS: Patients with prenatal hydronephrosis from seven centers were enrolled into the Society for Fetal Urology Hydronephrosis Registry from 2008-2020. Patients with ureteral measurement on ultrasound were included. Patients with ureterocele, ectopic ureter, neurogenic bladder, posterior urethral valves, horseshoe or solitary kidney, known ureteropelvic junction obstruction, or follow-up <1 month were excluded. Primary outcome was UTI. Analyses were performed using Cox regression. RESULTS: Of 1406 enrollees, 237 met inclusion criteria. Hydroureter of 7 mm was a significant threshold to differentiate patients at higher UTI risk. Patients with ureters ≥7 mm had almost three times the risk of UTI adjusting for sex, circumcision, CAP, and hydronephrosis grade (HR=2.7, 95% CI:1.1-6.5, p=0.03). In patients without vesicoureteral reflux (VUR), ureteral dilation ≥7 mm corresponded with higher UTI risk compared to ureteral diameter <7 mm on multivariable analysis (HR=4.6, 95% CI: 1.1-19.5, p=0.04; Figure 1). Conversely, in patients with VUR, ureteral diameter ≥7 mm did not impact UTI risk (HR=1.1, 95% CI:0.31-3.6, p =0.93). CAP was significantly protective against UTI for patients with hydroureter (HR=0.50, 95% CI: 0.28-0.87, p=0.01). CONCLUSIONS: This is the first prospectively collected, multicenter study to show that prenatal hydronephrosis with hydroureter ≥7 mm identifies a high UTI risk group who would benefit from antibiotic prophylaxis. In contrast, patients with prenatal hydronephrosis and non-refluxing hydroureter <7 mm may be managed more conservatively. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e276-e276 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Holzman More articles by this author Rebecca Zee More articles by this author Luis Braga More articles by this author C. D. Anthony Herndon More articles by this author Carol Davis-Dao More articles by this author Nora Kern More articles by this author Joshua Chamberlin More articles by this author Melissa McGrath More articles by this author Kai-wen Chuang More articles by this author Heidi Stephany More articles by this author Elias Wehbi More articles by this author Anne Dudley More articles by this author Valre Welch More articles by this author Gina Lockwood More articles by this author Jennika Finup More articles by this author Antoine Khoury More articles by this author Expand All Advertisement Loading ...