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Reported Variation in the Evaluation of Antenatal Hydronephrosis: Results of a Web-Based Survey of Pediatric Urologists
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Reported Variation in the Evaluation of Antenatal Hydronephrosis: Results of a Web-Based Survey of Pediatric Urologists
Michael E. Van Bibber, M.D., Daniel B. Herz, M.D., Paul A. Merguerian, M.D..
Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Background: There are no guidelines for the evaluation and management of antenatal hydronephrosis. We hypothesized that even among pediatric urologists there is variability in this area.
Methods: A web-based survey was sent to members of the Urology Section of the AAP and ESPU. Respondents answered questions concerning demographics and practice patterns in the management of antenatal hydronephrosis. Statistical analysis of was done by using the chi-squared test.
Results: Of the 156 respondents 78(50%) were from North America and 62(40%) from Europe. Radiographic factors influenced the decision to obtain further imaging or to use prophylactic antibiotics in around 50% of respondents (Table 1). There was wide variability in the parameters that triggered intervention. The use of prophylactic antibiotics ranged from 3% for antero-posterior pelvic diameter (APD) of <4mm to 70% for APD>10mm; 4% for grade I to 66% for grade IV, and 10% for VUR grade I to 80% for VUR grade V. There was also variability in the postnatal radiographic evaluation with no agreement on the use of US or VCUG greater than 80% for any given SFU grade. North American physicians were more likely to prescribe antibiotics for any prenatal hydronephrosis compared to their European counterparts (72% vs. 37%, p < 0.005), and European physicians more likely to be influenced by prenatal pelvic diameter when obtaining post-natal imaging (66% vs. 45%, p=0.015 if unilateral and 53% vs. 34%, p=0.023 if bilateral.)
Table of Contents
Table 1 | | | | Yes | No | | Unilateral hydronephrosis: Influence of APD on postnatal imaging | 56% | 44% | | Bilateral hydronephrosis: Influence of APD on postnatal imaging | 45% | 55% | | Unilateral Hydronephrosis: Obtaining imaging studies if postnatal ultrasound shows resolution | 48% | 52% | | Bilateral Hydronephrosis : Obtaining imaging studies if postnatal ultrasound shows resolution | 60% | 40% | | Influence of AP diameter on decision to place on prophylaxis | 42% | 58% | | Influence of SFU grading on decision to place on prophylaxis | 48% | 52% | | Influence of reflux grade on decision to place on prophylaxis | 42% | 58% | | Routine postnatal use of prophylactic antibiotics | 56% | 44% | | Routine use of antibiotics if postnatal ultrasound is normal | 17% | 83% |
Conclusions: There is considerable variation in resource utilization, both radiographic and use of prophylactic antibiotics, in the evaluation and treatment of antenatal hydronephrosis even among pediatric urologists. This variability is most probably due to the absence of clear guidelines based on prospective and controlled trials.
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