Practice pattern variations among North American AUA sections for the evaluation and treatment of prenatal hydronephrosis
Rebecca S. Zee1, Carol A. Davis-Dao2, Gina M. Lockwood3, Joshua D. Chamberlin4, Katherine W. Herbst5, Valre W. Welch1, CD Anthony Herndon1, Antoine E. Khoury2, Luis H. Braga6, Anne G. Dudley5, Kathryn E. Morgan7, Nora G. Kern7
1Children's Hospital of Richmond, Richmond, VA, 2CHOC Children's; University of California, Irvine, CA, 3University of Iowa Hospitals and Clinics, Iowa City, IA, 4Loma Linda University Health; CHOC Children's, Loma Linda, CA, 5Connecticut Children's Medical Center, Hartford, CT, 6Mcmaster Children's Hospital, Hamilton, Canada, 7University of Virginia, Charlottesville, VA
Introduction
There is a paucity of evidence regarding the utility of continuous antibiotic prophylaxis (CAP) and screening for vesicoureteral reflux (VUR) among children with prenatal hydronephrosis (PNH). Our aim was to determine the variation in practice patterns of prescribing CAP and obtaining voiding cystourethrography (VCUG) among children with PNH by AUA sections throughout North America.
Methods
Patients with confirmed PNH from six medical centers were enrolled into the prospective Society for Fetal Urology (SFU) Hydronephrosis Registry from 2008 to 2019. Exclusion criteria included missing data on key variables and follow-up time <1 month. Centers were categorized into the following sections: Northeastern (n=503), Mid-Atlantic (n=187), North Central (n=45), New England (n=93) and Western (n=309). PNH grade was defined as the highest SFU grade based on initial postnatal ultrasound. Low grade (LG) was categorized as SFU grade 0-2 and high grade (HG) was SFU grade 3-4. Proportions of CAP and VCUG use were calculated by AUA section and PNH grade.
Results
Patients (n=1137, 28% female) with PNH were identified from the total cohort of 1280 patients after applying exclusion criteria (n=143). There was variability in CAP use for PNH by section. The New England section had the highest CAP utilization (78.5%) whereas Western had the least (38.2%). Patients with HG PNH demonstrated higher rates of CAP use compared to LG PNH, except for the North Central section. Females were more commonly prescribed CAP than males in the Northeastern, Mid-Atlantic, and Western sections. There were differences in obtaining VCUG by section. The Northeastern section had the highest VCUG rates (73.6%) whereas the Mid-Atlantic had the lowest (16.58%). Patients with HG PNH were more likely to undergo VCUG compared to LG PNH in all sections except North Central.
Conclusions
There is variation across North America in practice patterns for initiating CAP and obtaining VCUGs in children with PNH. There was higher CAP utilization in female patients and patients with HG PNH in most sections. A higher proportion of HG PNH patients underwent VCUG imaging compared to LG PNH in most sections. There is wide variation in postnatal management of PNH. Evidence-based guidelines for the evaluation and management of PNH are needed.
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