Ureteral Dilation Is a Clinically Significant Risk Factor for Urinary Tract Infections in Children With Prenatal...

Area of Science:

• Pediatric Urology
• Nephrology
• Infectious Diseases

Background:

• Pediatric hydronephrosis increases the risk of urinary tract infections (UTIs).
• Clinical guidelines suggest continuous antibiotic prophylaxis (CAP) for high-risk infants.
• The association between specific hydronephrosis subtypes and UTI risk requires further clarification.

Purpose of the Study:

• To evaluate the association between hydroureteronephrosis and UTIs in infants with prenatal hydronephrosis.
• To determine if hydroureter or isolated hydronephrosis are significant risk factors for UTI development.
• To inform clinical guidelines regarding antibiotic prophylaxis for infants with prenatal hydronephrosis.

Main Methods:

• A single-center retrospective risk analysis of 803 infants with prenatal hydronephrosis (2015-2024).
• Data collected included demographic and imaging characteristics (anteroposterior diameter, SFU grade, ureter diameter).
• Landmark and competing risk analysis using cause-specific Cox regression identified UTI risk factors.

Main Results:

• A hydroureter was significantly associated with increased UTI risk (HR 1.15 per mm, p<0.001).
• Isolated hydronephrosis, based on SFU grade or APD, was not a significant UTI risk factor.
• The predictive model for UTI risk demonstrated good performance (concordance index 0.74).

Conclusions:

• The presence of a hydroureter on initial postnatal ultrasound is a key risk factor for UTIs in infants with prenatal hydronephrosis.
• This finding supports the use of continuous antibiotic prophylaxis (CAP) in infants with hydroureter.
• Isolated hydronephrosis alone does not appear to justify the routine use of antibiotic prophylaxis.