Department of Urology, University of Virginia, Charlottesville, VA, USA.
Department of Urology, University of Virginia, Charlottesville, VA, USA.
J Pediatr Urol. 2017 Dec;13(6):602-607. doi: 10.1016/j.jpurol.2017.03.032. Epub 2017 Apr 26.
Over the last decade the literature, including a multidisciplinary consensus statement, has supported a paradigm shift in management of urinary tract dilation, yet the impact on practice patterns has not been well documented.
This study aims to elucidate specific practice patterns for treatment of prenatal unilateral urinary tract dilation and to assess surgical intervention patterns for ureteropelvic junction obstruction.
An online survey was distributed to 234 pediatric urologists through the Society of Pediatric Urology. The survey was composed of five clinical case scenarios addressing evaluation and management of unilateral urinary tract dilation.
The response rate was 71% (n = 168). Circumcision status, gender, and grade were significant factors in recommending prophylactic antibiotics for newborn urinary tract dilation. Prophylactic antibiotic use in the uncircumcised male and female was twice that of a circumcised male for grade 3 (Table). This difference was minimized for grade 4. Use of VCUG was high for circumcised males with grade 3 or 4 (Table). The choice of minimally invasive surgery for ureteropelvic junction repair increased with age from 19% for a 5-month-old, 49% for a 2-year-old, and 85% for a 10-year-old. Notably, 44% of respondents would observe a 10-year-old with intermittent obstruction. Retrograde pyelography was recommended in conjunction with repair in 65% of respondents. Antegrade stent placement was the most common choice (38-47%) for urinary diversion after pyeloplasty. Regarding postoperative imaging, only 5% opted for routine renal scan whereas most would perform renal ultrasound alone.
Practice patterns seen for use of prophylactic antibiotics are in agreement with the literature, which promotes selective use in those at highest risk for urinary tract infections. Interestingly, use of aggressive screening was not concordant with this literature. Several studies have indicated an increased usage of robotic pyeloplasty; however, results indicate that minimally invasive surgery is not preferred in those younger than 6 months. Study limitations include use of clinical case scenarios as opposed to actual clinical practice.
Practice patterns for prophylactic antibiotic use for neonatal urinary tract dilation are dependent on gender, circumcision status, and grade. The use of minimally invasive surgery for ureteropelvic junction repair increased with patient age, with 50% preferring this modality at 2 years.
在过去的十年中，文献包括多学科共识声明，支持在管理尿路扩张方面的范式转变，但对实践模式的影响尚未得到很好的记录。
本研究旨在阐明治疗产前单侧尿路扩张的具体实践模式，并评估肾盂输尿管连接部梗阻的手术干预模式。
通过小儿泌尿外科协会向 234 名小儿泌尿科医生分发在线调查。该调查由五个临床病例组成，涉及单侧尿路扩张的评估和管理。
回复率为 71%（n=168）。是否行包皮环切术、性别和分级是推荐新生儿尿路扩张预防性使用抗生素的重要因素。未行包皮环切术的男婴和女婴预防性使用抗生素的比例是行包皮环切术的男婴的两倍，用于 3 级（表）。对于 4 级，这种差异最小化。对于 3 级或 4 级的行包皮环切术的男婴，使用静脉肾盂造影术的比例较高（表）。肾盂输尿管连接部修复的微创选择随着年龄的增长而增加，从 5 个月大的 19%、2 岁的 49%和 10 岁的 85%。值得注意的是，44%的受访者会观察到 10 岁间歇性梗阻的患者。65%的受访者建议在修复的同时进行逆行肾盂造影术。顺行支架置入术是肾盂成形术后最常见的尿流改道术选择（38-47%）。对于术后影像学检查，只有 5%的人选择常规肾扫描，而大多数人仅单独进行肾脏超声检查。
预防性使用抗生素的实践模式与文献一致，文献提倡在感染风险最高的患者中选择性使用。有趣的是，积极筛查的使用与文献不一致。几项研究表明，机器人肾盂成形术的使用有所增加；然而，结果表明，对于年龄小于 6 个月的患者，微创手术并不受欢迎。研究的局限性包括使用临床病例场景而不是实际的临床实践。
对于新生儿尿路扩张，预防性使用抗生素的实践模式取决于性别、包皮环切术状态和分级。肾盂输尿管连接部修复的微创选择随着患者年龄的增长而增加，50%的人在 2 岁时更喜欢这种方式。
