Vesicoureteral reflux and clinical outcomes in infants with prenatally detected hydronephrosis

Purpose: We evaluate the incidence of vesicoureteral reflux and urinary tract infections in infants with prenatally detected hydronephrosis. Materials and Methods: We retrospectively reviewed the charts of children referred to our hospital for evaluation of prenatally detected hydronephrosis between 1992 and 1998. Measured variables included ultrasound and voiding cystourethrogram findings, and infectious and clinical reflux outcomes. Results: Vesicoureteral reflux was identified in 40 of 234 infants (21%), including 24% of males and 13% of females. A significant correlation was found between the degree of hydronephrosis and incidence of reflux. Urinary tract infections were uncommon and identified in 7.5% of children on prevention for reflux and 4% with normal voiding cystourethrogram. In the majority (58%) of cases reflux resolved with medical management. Conclusions: The incidence of reflux increases with greater degrees of sonographic dilatation but a normal ultrasound does not exclude reflux and, therefore, voiding cystourethrogram is recommended in all children with prenatally detected hydronephrosis. Since urinary tract infections are uncommon with prevention, antibiotics should be continued until reflux resolves and/or hydronephrosis significantly improves.