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• W2034147146 abstract "No AccessJournal of UrologyDiagnostic Imaging1 Oct 2010Variation Among Pediatric Urologists and Across 2 Continents in Antibiotic Prophylaxis and Evaluation for Prenatally Detected Hydronephrosis: A Survey of American and European Pediatric Urologists Paul A. Merguerian, Daniel Herz, Leslie McQuiston, and Michael Van Bibber Paul A. MerguerianPaul A. Merguerian More articles by this author , Daniel HerzDaniel Herz More articles by this author , Leslie McQuistonLeslie McQuiston More articles by this author , and Michael Van BibberMichael Van Bibber More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.03.115AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: No clear practice guidelines exist to evaluate prenatally diagnosed hydronephrosis or recommend antibiotic prophylaxis. We hypothesized that among pediatric urologists there is significant variability in prenatal hydronephrosis evaluation and management. Materials and Methods: We created a survey questionnaire to answer certain questions, including 1) what prenatal parameters trigger postnatal evaluation, 2) how pediatric urologists manage prenatal hydronephrosis and 3) what are their recommendations for antibiotic prophylaxis. Survey questions included demographics and practice patterns, and influences concerning radiographic tests and prophylactic antibiotics. A Web based survey link was sent to members of the Urology Section, American Academy of Pediatrics and the European Society for Pediatric Urology. We received 156 responses. We also compared practices based in Europe in 60 respondents and in the United States in 70. Results: There was significant response variability to all questions answered with no question achieving a consensus of more than 50%. European and American respondents were equally distributed in regard to years in practice and number of patients per month. Radiographic factors influenced the decision to perform further imaging or provide prophylactic antibiotics in around 50% of respondents. There was wide variability in parameters triggering intervention and in prophylactic antibiotics. Pediatric urologists in practice more than 15 years were less likely to prescribe antibiotic prophylaxis at birth than those in practice less than 15 years. Variation also existed by geographic region with American physicians more likely to prescribe antibiotics for any prenatal hydronephrosis compared to their European counterparts (77% vs 40%, p <0.005) and European physicians more likely to be influenced by prenatal pelvic diameter when obtaining postnatal imaging (unilateral 70% vs 47%, p = 0.009 and bilateral 55% vs 36%, p = 0.03, respectively). European pediatric urologists were also more likely to order renal scans than their American counterparts. These differences were less significant for high grade hydronephrosis. Conclusions: Even among pediatric urologists there is considerable variation in radiographic resource and prophylactic antibiotics use when managing prenatal hydronephrosis. Some variation may be explained by regional differences but it is most probably due to absent clear guidelines based on prospective, randomized, controlled trials. References 1 : Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics2006; 118: 586. Google Scholar 2 : Antenatal diagnosis and subsequent management of hydronephrosis. J Urol1993; 149: 693. Link, Google Scholar 3 : Antenatal renal pelvis dilatation emphasizing vesicoureteric reflux: two-year follow-up of minor postnatal dilatation. Acta Paediatr2004; 93: 336. Google Scholar 4 : Antenatal hydronephrosis: evaluation and outcome. Curr Urol Rep2002; 3: 131. Google Scholar 5 : Postnatal management of antenatal hydronephrosis. BJU Int2002; 89: 149. Google Scholar 6 : Fetal pyelectasis: is it always “physiologic”?. Am J Obstet Gynecol1995; 173: 1263. Google Scholar 7 : Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol1993; 23: 478. Google Scholar 8 : Current management of infants with fetal renal pelvis dilation: a survey by French-speaking pediatric nephrologists and urologists. Pediatr Nephrol2004; 19: 966. Google Scholar 9 : Antenatal ultrasound screening for fetal abnormalities: a systematic review of studies of cost and cost effectiveness. BJOG2002; 109: 44. Google Scholar 10 : Effect of prenatal ultrasound screening on perinatal outcome: RADIUS Study Group. N Engl J Med1993; 329: 821. Google Scholar 11 : Fetal hydronephrosis: is there hope for consensus?. Pediatr Radiol2004; 34: 519. Google Scholar 12 : Primary vesicoureteral reflux detected in neonates with a history of fetal renal pelvis dilatation: a prospective clinical and imaging study. J Pediatr2006; 148: 222. Google Scholar 13 : Vesicoureteral reflux and urinary tract infection in children with a history of prenatal hydronephrosis—should voiding cystourethrography be performed in cases of postnatally persistent grade II hydronephrosis?. J Urol2009; 181: 801. Link, Google Scholar 14 : Natural history of neonatal reflux associated with prenatal hydronephrosis: long-term results of a prospective study. J Urol2003; 169: 1837. Link, Google Scholar 15 : Outcome of isolated antenatal hydronephrosis: a prospective cohort study. Pediatr Nephrol2007; 22: 1727. Google Scholar 16 : Prenatal hydronephrosis: early evaluation. Curr Opin Urol2008; 18: 401. Google Scholar Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByZareba P, Lorenzo A and Braga L (2014) Risk Factors for Febrile Urinary Tract Infection in Infants with Prenatal Hydronephrosis: Comprehensive Single Center AnalysisJournal of Urology, VOL. 191, NO. 5S, (1614-1619), Online publication date: 1-May-2014.Zanetta V, Rosman B, Bromley B, Shipp T, Chow J, Campbell J, Herndon C, Passerotti C, Cendron M, Retik A and Nguyen H (2018) Variations in Management of Mild Prenatal Hydronephrosis Among Maternal-Fetal Medicine Obstetricians, and Pediatric Urologists and RadiologistsJournal of Urology, VOL. 188, NO. 5, (1935-1939), Online publication date: 1-Nov-2012. Volume 184Issue 4SOctober 2010Page: 1710-1715 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Keywordsphysician's practice patternsprenatal diagnosisquestionnaireshydronephrosiskidneyAcknowledgmentsSurvey face validity was determined at the Pediatric Network for Quality Urology Initiatives.MetricsAuthor Information Paul A. Merguerian More articles by this author Daniel Herz More articles by this author Leslie McQuiston More articles by this author Michael Van Bibber More articles by this author Expand All Advertisement PDF DownloadLoading ..." @default.
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