Conservative management of primary non-refluxing megaureter during the first year of life: A longitudinal observational study

Renzo, Dacia Di; Persico, Antonello; Nicola, Marta Di; Silvaroli, Sara; Martino, Gabriel; Chiesa, Pierluigi Lelli

doi:10.1016/j.jpurol.2015.05.007

Cited by 17 publications

(23 citation statements)

References 24 publications

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“…A prospective observational study conducted by Di Renzo et al examined 47 children with 58 primary non-refluxing megaureters and found an overall rate of fUTI of 15%, with 6 (13%) of these patients requiring hospitalization. The majority of fUTIs developed after 6 months of age, contradictory to much of the current literature ( 42 ).…”

Section: Step 3 – Critical Appraisal Of the Literaturecontrasting

confidence: 78%

From Research Question to Conducting a Randomized Controlled Trial on Continuous Antibiotic Prophylaxis in Prenatal Hydronephrosis: A Rational Stepwise Process

et al. 2016

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Introduction and objectivesContinuous antibiotic prophylaxis (CAP) use to prevent urinary tract infections (UTI) in infants with prenatal hydronephrosis (HN) remains controversial. Lack of consensus guidelines and diverse practice patterns for postnatal management of HN highlight the dire need for higher level of evidence studies. Herein, we aim to describe the steps from developing a well-defined research question to execute a multicentered randomized controlled trial (RCT) to address the issue of CAP use in patients with prenatal HN.Materials and methodsThe steps involved were (1) choosing the proper research question, (2) survey of practice patterns and establishing clinical equipoise, (3) systematic review of the literature, (4) reviewing own practice, (5) longitudinal prospective study, (6) pilot study, (7) cost-utility analysis, and (8) definitive RCT (clinical trials registry number: NCT01140516). An update of our previous systematic review was conducted using two electronic databases and gray literature from 2010 to 2015. Eligibility criteria included studies of children <2 years old with postnatally confirmed prenatal HN, receiving CAP or not, and reporting on development of UTIs, capturing information on voiding cystourethrogram result and HN grade. Full-text screening was conducted by two independent reviewers. UTI rates in patients with high-grade HN were compared across different study designs. Finally, blinded comparative analysis of UTI rates between placebo and treatment groups was carried out using chi-square test.ResultsUTI rates in patients with high-grade HN by their respective study design were: 25% for systematic review, 20% for retrospective study, 21% for prospective and pilot studies, and 13% for the definitive RCT thus far. Regardless of the type of study design, patients with hydroureteronephrosis had significantly higher (threefold to sixfold) UTI rates than those with isolated HN. Our updated systematic review yielded 486 citations, of which 9 (n = 1987 infants) observational studies met eligibility criteria.ConclusionUTI rates in patients with high-grade HN dropped from 25% in observational studies to 13% in our RCT. This decline in UTI rate demonstrates that study designs lacking strategies to minimize bias are more prone to overestimate treatment effects. These findings highlight the importance of conducting methodologically sound RCTs to answer clinically meaningful questions, such as the one presented here.

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Section: Step 3 – Critical Appraisal Of the Literaturecontrasting

confidence: 78%

From Research Question to Conducting a Randomized Controlled Trial on Continuous Antibiotic Prophylaxis in Prenatal Hydronephrosis: A Rational Stepwise Process

et al. 2016

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“…However, in previous studies the results have been controversial. In one prospective study the patients with HUN and mild dilatation had a negligible risk for UTI whereas in another study there was a connection between nonrefluxing dilated ureters and UTIs [6,20].…”

Section: Discussionmentioning

confidence: 96%

Incidence of urinary tract infections in infants with antenatally diagnosed hydronephrosis—A retrospective single center study

Visuri

Jahnukainen

Taskinen

2017

Journal of Pediatric Surgery

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“…If the distribution of biases was roughly symmetrical, the pooled treatment effect estimate would be similar for both random-and fixed-effects models. 26 Differences in the pooled UTI estimates were observed between the fixedeffects (OR 0.75; 95% CI 0.58-0.96) and random-effects model (OR 0.84; 95% CI 0.45-1.55). The fixed-effects model did not decrease the heterogeneity (I 2 =77%), but was in agreement with the direction and non-significance of effect.…”

Section: Cap and Utimentioning

confidence: 93%

“…Four studies were conducted in Canada, [16][17][18][19] four in the U.S., [20][21][22][23] and one each were conducted in Germany, 24 Turkey, 25 and Italy. 26 Six studies 16,17,20,23,25,26 were prospective and five 18,19,21,22,24 retrospective. Following fulltext review, 84 articles were excluded because they were non-comparative studies, editorials, or case reports.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Antibiotic prophylaxis for prevention of urinary tract infections in prenatal hydronephrosis: An updated systematic review

Easterbrook¹,

Capolicchio²,

Braga³

2017

CUAJ

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Introduction: While continuous antibiotic prophylaxis (CAP) is currently recommended to prevent urinary tract infections (UTIs) in infants with prenatal hydronephrosis (HN), this recommendation is not evidence-based. The objective of this study was to systematically determine whether CAP reduces UTIs in the HN population. Methods: Applicable trials were identified through an electronic search of MEDLINE (1946MEDLINE ( -2015, EMBASE (1980EMBASE ( -2016, CINAHL (1982), and CENTRAL (1993 and through a hand search of American Urological Association (AUA) (2012)(2013)(2014)(2015) and European Society for Pediatric Urology (ESPU) (2012)(2013)(2014)(2015) abstracts, as well as reference lists of included trials. The search strategy was not limited by language or year of publication. Eligible studies compared CAP to no CAP in patients with antenatal HN, <2 years of age, and reported development of UTI and HN grades. Two independent reviewers performed title and abstract screening, full-text review, and quality appraisal. Results: Of 1518 citations screened, 11 were included, contributing 3909 patients for final analysis. Of these, four (36%) were considered high-quality when assessed by the Newcastle Ottawa Scale. Meta-analysis of the non-randomized trials (n=10) provided similar pooled UTI rates, regardless of CAP use: 9.9% (95% confidence interval [CI] 8.4-11.4%) for CAP and 7.5% (95% CI 6.4-8.6%) for no CAP. Conclusions: This systematic review and meta-analysis suggests there may be value in providing CAP to infants with high-grade HN; however, due to the very low-quality data from non-randomized studies, important clinical variables, such as circumcision status, were unable to be assessed.

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Conservative management of primary non-refluxing megaureter during the first year of life: A longitudinal observational study

Cited by 17 publications

References 24 publications

From Research Question to Conducting a Randomized Controlled Trial on Continuous Antibiotic Prophylaxis in Prenatal Hydronephrosis: A Rational Stepwise Process

From Research Question to Conducting a Randomized Controlled Trial on Continuous Antibiotic Prophylaxis in Prenatal Hydronephrosis: A Rational Stepwise Process

Incidence of urinary tract infections in infants with antenatally diagnosed hydronephrosis—A retrospective single center study

Antibiotic prophylaxis for prevention of urinary tract infections in prenatal hydronephrosis: An updated systematic review

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