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Ureteral Dilation Is a Clinically Significant Risk Factor for Urinary Tract Infections in Children With Prenatal
Adree Khondker1,2, Mandy Rickard1, Samer Maher1
1Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Hydroureter in infants with prenatal hydronephrosis significantly increases urinary tract infection (UTI) risk. Isolated hydronephrosis does not warrant antibiotic prophylaxis, but hydroureter presence supports its use for UTI prevention.
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.
Purpose:
Pediatric hydronephrosis is associated with an increased risk of UTIs. Clinical guidelines recommend continuous antibiotic prophylaxis for high-risk patients. In this study, we evaluated the association between hydroureteronephrosis and UTIs in infants.
Materials And Methods:
We performed a single-center retrospective risk analysis of patients with prenatal hydronephrosis from 2015 to 2024, including those with isolated hydronephrosis and megaureter. Demographic and imaging characteristics, including anteroposterior diameter, Society for Fetal Urology grade, and maximum ureter diameter on first postnatal ultrasound, were recorded. The primary outcome was time to UTI development. Landmark analysis and competing risk analysis with cause-specific Cox regression were used to identify HRs. Model performance was determined by the concordance index.
Results:
Among 803 patients (median follow-up 23 months) included in landmark analysis, 29 developed a UTI. On initial ultrasound, 124 patients had hydroureteronephrosis and 451 patients had high-grade hydronephrosis. On cause-specific Cox regression, UTI was associated with sex, uncircumcised status, hydroureter (HR 1.15 per mm, 95% CI: 1.10, 1.21, P < .001), whereas hydronephrosis alone, by Society for Fetal Urology grade or anteroposterior diameter, was not significantly associated. Model performance showed concordance index 0.74 (optimism-adjusted 0.72).
Conclusions:
The presence of a hydroureter on initial postnatal ultrasound is a significant risk factor for UTI in infants with prenatal hydronephrosis, which supports the value of continuous antibiotic prophylaxis in this subgroup. By contrast, isolated hydronephrosis does not seem to justify the use of prophylaxis.
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