Abstract
Introduction
The utility of continuous antibiotic prophylaxis (CAP) and voiding cystourethrograms (VCUG) in prenatal hydronephrosis is highly debated. Using data from a multicenter cohort, we trended CAP prescription, VCUG utilization, and urinary tract infection (UTI) rates across hydronephrosis subgroups.
Methods
A multicenter cohort data analysis was performed using patients with prenatal hydronephrosis and ≥3 months of urology follow-up. Patients were stratified into groups: isolated hydronephrosis (n=1,636) and hydroureteronephrosis (≥7mm ureteral dilation (n=308)). CAP was defined as any prescription during the follow-up period. Confirmed UTI required fever, pyuria, a single-organism positive culture from catheterization or clean-catch specimen, and antibiotic treatment. Temporal trends were analyzed by year of first visit across six cohorts spanning 2007-2024.
Results
1,944 patients met inclusion criteria. Among patients with isolated hydronephrosis, CAP prescription (p0.0001) and VCUG utilization (p0.0001) showed significantly decreasing trends over the study period, while UTI rates remained stable (range 1.6–4.5%; p=0.24).
In contrast, CAP rates (p=0.52) and VCUG utilization (p=0.46) remained stable over time in hydroureteronephrosis patients. UTI rates were similarly unchanged (p=0.21), though this group’s UTI rate was substantially higher (overall 14.6%).
Conclusion
Since 2007, CAP prescription and VCUG utilization have decreased significantly in patients with isolated hydronephrosis without an increase in confirmed UTI rates, supporting the safety of conservative management in this population. Meanwhile, hydroureteronephrosis management remained consistent, reflecting higher infection risk in this group. These findings support reduction of antibiotic prophylaxis and invasive imaging in isolated hydronephrosis with continued need for surveillance in hydroureteronephrosis.