Ces Urol 2013, 17(3):193-198 | DOI: 10.48095/cccu2013027

Is it appropriate to administer antibiotic prophylaxis to infants with severe hydronephrosis before pyeloplasty?

Oldřich Šmakal¹, Jan Šarapatka¹, Hana Flögelová², Lenka Bakaj-Zbrožková³

¹ Urologická klinika LF UP a FN, Olomouc

² Dětská klinika LF UP a FN, Olomouc

³ Radiologická klinika LF UP a FN, Olomouc

Aim:
The aim of this study was to assess the development of acute pyelonephritis (APN) in infants with hydronephrosis, detected using ultrasonography (USG), and severe uretero-pelvic junction obstruction requiring pyeloplasty. Based on the results, we evaluated the necessity for antibiotic prophylaxis until the time of surgery.

Methods:
A prospective study was performed to assess the presence of APN prior to pyeloplasty in infants with severe dilatation of the renal pelvi-calyceal system (PCS). The infants underwent standard USG and MAG3 scintigraphy examinations. In those with APN, a voiding cystourethrogram was performed. During follow-up, none of the infants received primary antibiotic prophylaxis; none of the male infants were circumcised. The analysis included USG and radionuclide parameters, age and gender.

Results:
A total of 97 infants underwent surgery. APN was found in 5 boys (5.2%) with a mean age of 1.4 months. Infants with a history of urinary tract infection had a renal pelvic diameter of 11-22mm, parenchymal thickness of 2-7mm and relative kidney function of 40-54%. There was no statistically significant association between APN and age, gender and USG or radio-nuclide parameters. Substantive significance of APN was found in boys less than 3 months of age compared with girls of the same age and infants older than 3 months.

Conclusion:
The results suggest that routine administration of antibiotic prophylaxis is not necessary in infants during follow-up for severe dilatation of the PCS. Prophylaxis should be individually considered in boys less than 3 months of age who most frequently developed APN.

Keywords: acute pyelonephritis, antibiotic prophylaxis, hydronephrosis, pyeloplasty

Received: April 30, 2013; Accepted: June 13, 2013; Published: June 1, 2013