Introduction

Voiding cystourethrogram (VCUG) may be ordered in infants during workup of prenatal hydronephrosis (HN) or after febrile urinary tract infection (fUTI). Definitive guidelines regarding VCUG indications and prescription of continuous antibiotic prophylaxis (CAP) are lacking, resulting in a diverse clinical practice. This study aimed to explore current practice patterns amongst pediatric urologists.

Methods

An online survey was distributed to members of the Society for Fetal Urology (SFU) to assess practice patterns surrounding VCUG and CAP use in infants. To ensure face and content validity, the survey was developed by experts in the field and piloted locally. Anonymized responses were analyzed according to HN etiology (isolated HN vs. hydroureteronephrosis [HUN]) and grade (low vs. high SFU), gender and circumcision status, as well as the use of antibiotics for prevention of post-VCUG UTI.

Results

Response rate was 37% (109/297), with 86 (79%) respondents coming from an academic setting. No difference was observed regarding use of CAP or VCUG indications for unilateral vs. bilateral HN or between genders/circumcision status. In contrast, regardless of HN etiology and gender, an expected difference in CAP use was observed between low grade HN (SFU I/II) vs. high grade HN (SFU III/IV) (p<0.001). Most respondents recommended CAP and VCUG to infants with high grade HUN (Table 1). For infants with their 1st fUTI and a normal ultrasound (US), we observed that more respondents would order VCUG for males (74%) and females (77%) 0-2 mos. compared to male (54%) and female (53%) infants 2-24 mos. (p<0.01). No significant difference was found when comparing VCUG indications for a 1st fUTI for male and female infants 0-2 and 2-24 mos. with abnormal US. Over 90% of respondents indicated that they would order VCUG regardless of gender or age for this cohort. Despite 85% of clinicians reporting that they had observed a UTI after VCUG, only 31 (28%) empirically treated to avoid a potential post-VCUG UTI.

Conclusions

This is the largest study to date assessing pediatric urology practice patterns in evaluating subtypes of prenatal HN. Despite being a common condition, our study demonstrates VCUG and CAP practice patterns vary substantially. Surprisingly, CAP use and VCUG indications were minimally affected by gender and HN laterality. However, their use was much more common in infants with high vs. low grade HN, as well as those with HUN compared to isolated HN.

Funding

None