Can suppressive antibiotics be avioded in the postnatal management of antenatally detected obstructive hydronephrosis?

Reddy, Sreedhar V and Chawla, Arun and Thomas, Joseph (2007) Can suppressive antibiotics be avioded in the postnatal management of antenatally detected obstructive hydronephrosis? Indian Journal of Urology, 23 (3). pp. 337-338.

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This paper retrospectively evaluated the role of prophylactic antibiotics in the postnatal management of antenatally detected obstructive hydronephrosis. 105 neonates (82 males and 23 females) with grade III or IV fetal hydronephrosis were followed up between 1994 and 2004. Hydronephrosis was graded by the Society of Fetal Urology (SFU) ultrasound grading system. The study also tried to correlate the chances of getting urinary tract infection (UTI) and the level of upper urinary obstruction. None of the patients in this study received prophylactic antibiotics. All the 82 males were not circumcised. 99 neonates in the study had unilateral and 6 had bilateral hydronephrosis. All the patients had an obstructive pattern in the diuretic renogram with half time of 20 minutes or more. 75 patients had ureteropelvic junction obstruction (UPJO) and 30 had lower urinary obstruction (LUO). The clinical course of the patients was reviewed for 12 months. In those neonates who developed UTI, corrective surgery was performed. The overall incidence of UTI during the follow up period was 36.2% (38 patients). Majority of the cases occurred before 6 months of age (92.8%). The mean age of onset of UTI was 2.6 months. There was a significant difference noted in the incidence of UTI and the level of obstruction. While UTI developed in 50% of patients with LUO, only 30.7% of patients with UPJO developed UTI. In the LUO group, the incidence of UTI was 70% in those with ureterocele, 50% in those with ectopic ureter and 38.9% in those with ureterovesical junction obstruction. 77 neonates (73.3%) underwent corrective surgery at a mean age of 3.8 months. The incidence of UTI before surgical correction was 33.8% at a mean age of 2.1 months. The multivariate analysis showed that the level of obstruction in the operated cases was the only significant variable in the development of UTI - 54.2% for LUO vs. 24.5% for UPJO. 12 of the 28 patients (42.9%) followed up without surgery developed UTI. Of the 6 patients with bilateral UPJO, 2 (33.3%) developed UTI.

Item Type: Article
Subjects: Medicine > KMC Manipal > Urology
Depositing User: KMC Manipal
Date Deposited: 31 May 2012 04:44
Last Modified: 31 May 2012 04:44

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