Value of screening for vesicoureteral reflux in infants with antenatal hydronephrosis in king abdulaziz medical city-Riyadh

Abstract

Background: Antenatal hydronephrosis (AHN) is diagnosed in 0.5%–1% of pregnancies. Hydronephrosis has many causes, but vesicoureteral reflux (VUR) remains an important cause, as it could lead to serious damage to the kidneys. Screening for VUR by voiding cystourethrogram (VCUG) is done in infants with congenital hydronephrosis to detect VUR that could lead to repeated urinary tract infections (UTIs). Objectives: The aim of the study was to investigate the value of VCUG as a screening tool for VUR in infants with various grades of hydronephrosis. Materials and Methods: This is a retrospective chart review for all infants with antenatal hydronephrosis between January 2010 and December 2015 at King Abdulaziz Medical City-Riyadh. Comparisons were made between hydronephrosis grades and VUR. Differences, therefore, were assessed for statistical significance using Chi-square test as appropriate. Analysis was performed using SPSS version 22. Results: During the study periods, 203 infants (75% of the study population) underwent VCUG. VUR was diagnosed in 21% of all infants who had VCUG. VUR was significantly higher in infants with high grade compared to low-grade hydronephrosis (30% versus 14.40%, P = 0.005). On the other hand, no significant difference found between high-grade hydronephrosis and low-grade hydronephrosis in the severity of VUR (P = 0.169). Meanwhile, high-grade hydronephrosis was significantly more associated with UTI 27.20% (25/92) than low-grade hydronephrosis 14.70% (26/177). Conclusion: Infants with antenatal hydronephrosis (HN) suffer greater morbidity as reflected by the increased incidence of VUR and UTI at follow-up. For high-grade HN, our recommendation clearly goes with the current practice for doing VCUG to all high-grade patients. On the other hand, the risk of VUR and UTI, although higher in infants with high-grade HN is still substantial in infants with low-grade HN. However, it is still controversial to do VCUG for them. Hence, we recommend further big researches about low-grade HN and VCUG to come up with clear conclusion for this HN group.