Ureteropelvic Junction Obstruction in Children: Is Antibiotic Prophylaxis Really Necessary?

Ureteropelvic Junction Obstruction In Children

  • Abdusattor A. Nosirov Department of Pediatric Surgery, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
  • Temur T. Narbaev Assistant Professor, Department of Pediatric Surgery, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
  • Fatkhulla F. Bayakhmedov Department of Pediatric Surgery, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
Keywords: Prenatal, hydronephrosis, urinary tract infection, child

Abstract

Background: To assess the risks of developing of urinary tract infection in children with ureteropelvic junction obstruction, depending on the grade of hydronephrosis. Materials and Methods. The present retrospective study, which was conducted from 2013 to 2018 years, includes data of 131 children with antenatally diagnosed grade III and IV hydronephrosis (SFU). All patients underwent surgical treatment at the age from 3 months to 3 years and did not receive antibiotic prophylaxis. Urinary tract infection was diagnosed in the presence of WBC in urine sample (> 10 WBC/field of view), positive bacterial growth ( 105 CFU/ml) and fever ( 38.5 C). Children with duplex system, obstructive megaureter, vesicoureteral reflux, posterior urethral valve, and neurogenic bladder were excluded from this study. Results. Grade III hydronephrosis was detected in 113 children and grade IV in 18 patients. The total incidence of urinary tract infection was 9.2% (12 patients), while in the group   of children with grade IV hydronephrosis it was higher (in 3 of 18 - 16.7%) than in children with grade III (in 9 out of 113 - 7.9%) (P <0.05). The incidence of urinary tract infections did not differ significantly depending on the sex or age of the patients. In 7 (58.3%) patients, urinary tract infection was noted before the age of 6 months, with an average age of 2.7 months. A bacteriological study revealed that in eight (66.7%) patients, E. Coli was the causative agent of urinary tract infection. Conclusion. Children with antenatal diagnosed and postnatal confirmed ureteropelvic junction obstruction do not need antibiotic prophylaxis because of the low incidence of urinary tract infection. However, patients with grade IV hydronephrosis under the age of 6 months should be closely follow-up by physicians for the early diagnosis and treatment of urinary tract infection.

References

1. Braga LH, Mijovic H, Farrokhyar F, Pemberton J, DeMaria J, Lorenzo AJ. Antibiotic Prophylaxis for Urinary Tract Infections in Antenatal Hydronephro- sis. Pediatrics. 2013;131(1):251–261. Available from: https://dx.doi.org/10.1542/peds.2012-1870.
2. Mudrik-Zohar H, Meizner I, Bar-Sever Z, Ben-Meir D, Davidovits M. Prenatal sonographic predictors of postnatal pyeloplasty in fetuses with isolated hydronephrosis. Prenatal Diagnosis. 2015;35(2):142–147. Available from: https://dx. doi.org/10.1002/pd.4505.
3. Sharkov SM, Rusakov AA, Semikina EL. Urine cell composition in children with monolateral hydronephrosis. Detskaya khirurgiya. J Pediatr Surg. 2014;4:20–22.
4. Gubarev VI, Zorkin SN, Shakhnovsky DS; 2017. Avail- able from: http//dx.doi.org/10.18821/1560-9510-2017-21-5- 262-266.Russian.
5. Chertin B, Pollack A, Koulikov D, Rabinowitz R, Hain D, Hadas-Halpren I. Conservative Treatment of Ureteropelvic Junction Obstruction in Children with Antenatal Diagnosis of Hydronephrosis: Lessons Learned after 16 Years of Follow- Up. Eur Urol. 2006;49(4):734–739. Available from: https:
//dx.doi.org/10.1016/j.eururo.2006.01.046.
6. Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: Introduction to the system used by the society for fetal urology. Pediatr Radiol. 1993;23(6):478–480. Available from: https://dx.doi.org/10.1007/bf02012459.
7. Visuri S, Jahnukainen T, Taskinen S. Incidence of uri- nary tract infections in infants with antenatally diagnosed hydronephrosis—A retrospective single center study. J Pedi- atr Surg. 2017;52(9):1503–1506. Available from: https://dx. doi.org/10.1016/j.jpedsurg.2016.11.038.
8. Lee JH, Choi HS, Kim JK. Nonrefluxing neonatal hydronephrosis and the risk of urinary tract infection. J Urol. 2008;179:1524–1528. Available from: https://doi.org/10.1016/ j.juro.2007.11.090.
9. Song SH, Lee SB, Park YS, Kim KS. Is antibiotic prophylaxis necessary in infants with obstructive hydronephrosis? J Urol. 2007;177:1524–1527. Available from: https://doi.org/10.1016/ j.juro.2006.11.002.
10. Roth CC, Hubanks JM, Bright BC, Heinlen JE, Donovan BO, Kropp BP. Occurrence of Urinary Tract Infection in Children With Significant Upper Urinary Tract Obstruction. Urology. 2009;73(1):74–78. Available from: https://dx.doi.org/10.1016/ j.urology.2008.05.021.
11. Nosirov AA, Narbaev TT, Bayakhmedov FF. Frequency and Risk Factors of Stone Formation in Kidneys of Children Experience of the Urology Department of Clinic of Tashpmi 1995-2019. J Adv Med Dent Scie Res. 2021;9(4):71–76.
12. Narbaev TT, Nosirov AA, Terebaev BA, Turaeva NN, Tilavov UK, Bayakhmedov FF. Assessment of the State of the Rectal Sphincter Apparatus in Anal Incontinence in Children after Surgery. J Adv Med Dent Scie Res. 2020;8(9):69–73.
13. Nosirov AN, Bayakhmedov FF, Sobitov IZ. Composition and structure of kidney stones in children with primary hyperparathyroidism. J Adv Med Dent Scie Res. 2020;8(9):86– 90.
14. Nosirov AA, Sobitov IZ. Osteodystrophy in Children with the Renal form of Primary Hyperparathyroidism. AJUR. 2019;2(1):1–5.
15. Islek A, Güven AG, Koyun M, Akman S, Alimoglu E. Prob- ability of urinary tract infection in infants with ureteropelvic junction obstruction: is antibacterial prophylaxis really needed? Pediatr Nephrol. 2011;26(10):1837–1841. Available from: https://dx.doi.org/10.1007/s00467-011-1889-7.
16. Agzamkhodjaev ST, Abdullaev ZB, Nosirov AA, Terebayev BA, Tilavov UX. Pyeloplasty in Children: Advantages of External Trans-Anastomotic Drainage. Indian J Med Forensic Med Toxicol. 2020;14(4):7229–7232. Available from: https://doi.org/10.37506/ijfmt.v14i4.12788.
17. Morozov DA, Morozova OL, Zakharova NB, Lakomova D, Yu. Modern principles of diagnosis and prediction of course of chronic obstructive pyelonephritis in children. Urologiia. 2013;3:68–73.
Published
2021-05-06