Evidence map›Paper›PMID 41706129›Full record

ArticlePediatric nephrology (Berlin, Germany)2026

Safely limiting the use of antibiotic prophylaxis and invasive testing in asymptomatic children with antenatally detected hydronephrosis.

Mandy Rickard, Adree Khondker, Joana Dos Santos, Samer Maher, Innocent Nzeyimana, Rahim Dhalla, Nithiakishna Selvathesan, Cal Robinson, Ailish Coblentz, Gillian Hunter and 2 more

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Article in Pediatric nephrology (Berlin, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

12 authors.

Mandy RickardDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada. mandy.rickard@sickkids.ca.ORCID http://orcid.org/0000-0003-0598-1824
Adree KhondkerDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Joana Dos SantosDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Samer MaherDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Innocent NzeyimanaDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Rahim DhallaSchulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
Nithiakishna SelvathesanDivision of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Cal RobinsonDivision of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Ailish CoblentzDepartment of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
Gillian HunterDepartment of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
Michael ChuaDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Armando J LorenzoDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAntenatal hydronephrosis (HN) is the most common congenital urinary tract abnormality, but management is controversial. Current guidelines recommend continuous antibiotic prophylaxis (CAP), voiding cystourethrogram (VCUG), and diuretic renal scintigraphy (DRS) for high-grade HN, yet these measures may expose many asymptomatic infants to unnecessary antibiotics, radiation, and anesthesia. We evaluated whether a selective approach-reserving CAP for hydroureteronephrosis (HUN), limiting VCUG to HUN or confirmed urinary tract infection (UTI), and using DRS only when ultrasound trends were equivocal-could reduce interventions without increasing adverse outcomes.

methodsWe conducted a retrospective cohort study of 1,008 consecutive infants (< 24 months) with isolated HN or HUN (2015 and 2025). Patients were grouped by treatment era: 2015-2018 (pre-protocol), 2019-2021 (implementation), and 2022-2025 (post-clinic). Outcomes included use and duration of CAP, VCUG, and DRS, UTI incidence, and timing of surgery.

resultsVCUG (52% → 28%) and DRS (58% → 30%) use declined significantly over time. Median CAP duration decreased from 7.7 to 2.9 months (p < 0.001). Surveillance UTI rates remained stable (2-4%, p = 0.74). In isolated HN, CAP conferred no measurable benefit (number needed to treat [NNT] 100), whereas in HUN, CAP reduced infections (6% vs. 21%; NNT 27).

conclusionsSelective management of antenatal HN-avoiding routine CAP, VCUG, and DRS in most infants-safely reduces unnecessary interventions without increasing UTI risk or delaying surgery. CAP should be reserved for higher-risk groups, such as infants with HUN, particularly uncircumcised males. These findings support updating international guidelines toward risk-based, individualized care.

Indexed as

Antibiotic ProphylaxisHydronephrosisUrinary Tract InfectionsAnti-Bacterial AgentsAsymptomatic DiseasesCystographyFemaleHumansInfantInfant, NewbornMalePractice Guidelines as TopicRadionuclide ImagingRetrospective StudiesUnnecessary ProceduresAnti-Bacterial AgentsContinuous antibiotic prophylaxisDiagnostic imagingHydronephrosisMegaureterPractice guidelines

Identifiers

PMID41706129

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.