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Prenatal complicated duplex collecting system and ureterocele-Important risk factors for urinary tract infection
Sofia Visuri1, Timo Jahnukainen2, Seppo Taskinen1
1Department of Pediatric Surgery, Helsinki University Hospital, Helsinki, Finland.
Insights
Infants with prenatally detected complicated urinary tract issues like ureterocele or duplex collecting system face a high risk of urinary tract infections (UTIs). Early endoscopic perforation may be considered for ureteroceles to reduce infection rates.
Area of Science:
- Pediatric Urology
- Nephrology
- Medical Diagnostics
Background:
- Prenatal detection of urinary tract abnormalities is crucial for early intervention.
- Complicated duplex collecting systems (CDS) and ureteroceles are associated with potential urinary tract complications.
Purpose of the Study:
- To evaluate the risk of urinary tract infections (UTIs) in infants diagnosed with prenatally detected complicated duplex collecting system (CDS) or ureterocele.
Main Methods:
- Retrospective analysis of patients with prenatally detected CDS or single system ureterocele (2003-2013).
- Complicated cases included ureterocele, vesicoureteral reflux (VUR), or nonrefluxing megaureter.
- UTI prevalence was compared between affected patients and 66 controls.
Main Results:
- 44% of patients experienced at least one UTI compared to 5% of controls (p<0.001).
- UTIs occurred prior to surgery in 31% with ureterocele and 57% with both ureterocele and VUR.
- Postoperative UTIs were observed in 29% of girls, with a 14% incidence after ureterocele perforation.
Conclusions:
- Children with prenatally detected ureterocele or CDS with nonrefluxing megaureter have a high risk of UTI, even with prophylactic antibiotics.
- Early endoscopic perforation of prenatally detected ureteroceles is suggested to mitigate UTI risk.
Purpose:
To evaluate the risk of urinary tract infections (UTIs) in infants with prenatally detected complicated duplex collecting system (CDS) or ureterocele.
Materials And Methods:
All patients with prenatally detected CDS (n=34) or single system ureterocele (n=7) who were admitted to our institution between 2003 and 2013 were enrolled in this retrospective analysis. Duplex collecting systems with ureterocele (n=13), vesicoureteral reflux (VUR) (n=20) or nonrefluxing megaureter without ureterocele (n=7) were determined as complicated. Twenty-six (63%) patients were females. The prevalence of UTI was compared to 66 controls.
Results:
The median follow-up time was 5.5 (1.7-12.2) years. Eighteen (44%) patients and 3 (5%) controls had at least one UTI (p<0.001) at the median age of 0.8 and 0.4years, respectively (p=0.481). Fifty-seven percent of the UTIs were breakthrough infections and 82% of those were non-Escherichia coli infections. UTIs occurred prior to any surgical intervention in 4/13 (31%) patients with ureterocele, in 2/14 (14%) patients with VUR, in 4/7 (57%) patients with both ureterocele and VUR, and in 3/7 (43%) patients with nonrefluxing megaureter without VUR or ureterocele (p-values 0.012, 0.209, 0.001 and 0.010, respectively, compared to controls). Postoperative UTIs were observed in 29% of the girls and in none of the 11 boys (p=0.072). The incidence of UTI after perforation of ureterocele was only 14%.
Conclusions:
Children with prenatally detected ureterocele or duplex collecting system associated with nonrefluxing megaureter are at high risk of UTI despite prophylactic antibiotics. In case of prenatally detected ureterocele we suggest to consider early endoscopic perforation.
Level Of Evidence:
III.
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