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TOPLINE:

In children with prenatal hydronephrosis, hydroureter was associated with an increased risk for urinary tract infections (UTIs), whereas the severity of hydronephrosis was not.

METHODOLOGY:

• Researchers conducted a retrospective analysis to evaluate the association between hydroureter — abnormal enlargement or dilation of a ureter — and the risk for UTIs in children with prenatal hydronephrosis, the most common anomaly detected by prenatal ultrasound, affecting roughly 1% of pregnancies.
• The analysis included 803 children younger than 2 years of age (656 boys) with a history of prenatal dilation of the kidney or ureter who were seen at a quaternary referral center between 2015 and 2024.
• Hydroureter was defined as a ureteral diameter ≥ 7 mm.
• The primary outcome was the time to a febrile UTI, defined as fever exceeding 101.3 °F with pyuria and a positive urine culture showing a single organism.
• The median follow-up duration was 23 months, with follow-up starting 3 months after the first ultrasound following birth.

TAKEAWAY:

• Febrile UTI developed in 3.6% of children, occurring at a median age of 28 months.
• Patients with hydroureter of 7-10 mm (hazard ratio [HR], 4.35; P < .001) and those with a ureteral diameter > 10 mm (HR, 8.65; P < .001) showed an increased risk for UTIs.
• Hydroureter, female sex, and uncircumcised status were independently associated with a higher risk for UTIs, while the severity of hydronephrosis was not significantly associated with the risk for UTIs.

IN PRACTICE:

“Our findings provide compelling evidence that should reshape widespread prophylactic practices. Specifically, by enabling the selective identification of truly high-risk populations, our data support a move away from conventional, broad-based CAP [continuous antibiotic prophylaxis] recommendations,” the authors of the study wrote. “Infants with hydroureter on postnatal ultrasound assessment are likely to benefit from CAP, whereas isolated high-grade hydronephrosis should not.”

SOURCE:

The study was led by Adree Khondker, Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada. It was published online on June 01, 2026, in The Journal of Urology.

LIMITATIONS:

The exclusion of patients without adequate follow-up may have led to an underestimation of risk in those with early events.

DISCLOSURES:

The authors reported receiving no funding for the study. The authors disclosed having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.