Pediatric UrologyEvaluating Practice Patterns in Postnatal Management of Antenatal Hydronephrosis: A National Survey of Canadian Pediatric Urologists and Nephrologists
Section snippets
Survey Design
An anonymous survey was designed on the open source web application “Lime Survey” (http://www.limesurvey.org, accessed November 2012.). The survey was locally piloted among pediatric urologists and pediatric nephrologists to confirm content and face validity and to decrease measurement bias. The survey was subsequently refined to 20 questions that focused solely on the practice patterns surrounding CAP and VCUG evaluation in patients with AHN.
The survey questions were divided into 3 main
Results
The survey was distributed to a total of 139 pediatric specialists. The overall response rate was 63.3% (88 returned surveys; 95% confidence interval, 55.0%-71.0%). The respondents identified themselves as pediatric nephrologists (n = 46) or pediatric urologists (n = 39), with only 3 failing to disclose this information. The respondents reported seeing an average of 50 patients with AHN each year (1-450). Overall, 49 physicians (61%) practiced in academic centers, 22 (27%) in freestanding
Comment
Although concern for developing a UTI was the major factor for instituting CAP by nephrologists and urologists, several important differences in AHN management were noted between representatives of these specialties. Generally, nephrologists and urologists appear to agree on the perceived lack of CAP benefit in children with unilateral low-grade AHN; however, there were important discrepancies for bilateral and high grades of AHN. Pediatric nephrologists institute CAP more readily for patients
Conclusion
The differences in the preference for prescribing CAP and recommending VCUGs for patients with AHN captured by this survey highlight the paucity of high-level data and well-defined clinical guidelines. Based on the disparities encountered, it appears that clinical equipoise exists, calling for the conduct of randomized placebo-controlled trials to improve the quality of evidence on this matter.
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Cited by (31)
A guide to evaluating survey research methodology in pediatric urology
2021, Journal of Pediatric UrologyCitation Excerpt :The clinical decision inspires you to conduct a search for differences in management strategies of AHN between pediatric urologists and nephrologists. The example survey of interest was conducted in 2014 comparing the management of antenatal hydronephrosis (AHN) between pediatric urologists and nephrologists in Canada [3]. A 20-question survey was disseminated online to a total of 139 specialists.
Value of urinary carbohydrate antigen 19–9 to predict failure of conservative management in children with ureteropelvic junction obstruction
2019, Journal of Pediatric SurgeryCitation Excerpt :Various imaging modalities including US, intravenous urography, voiding cystourethrogram, and diuretic renography may be necessary to confirm the diagnosis; however, definitive diagnosis may remain equivocal in some patients. Proper management of patients with UPJO is still a clinical challenge [12] and clear indications and timing for surgical intervention are debatable. A growing concern remains among experts that the available indications for surgery may not have the potential capability to select the patients who require surgery nor define the appropriate timing of surgery [13].
Continuous Antibiotic Prophylaxis in Pediatric Urology
2018, Urologic Clinics of North AmericaCitation Excerpt :Although it is thought that CAP may prevent UTI in children with prenatal HN, it is yet to be proved. An RCT comparing trimethoprim with placebo in infants with SFU grades III to IV HN is currently underway in order to answer this question.77 Therefore, some investigators suggest institution of CAP at birth, whereas others, instead, recommend a low threshold for investigation and treatment of a suspected UTI.
Financial Disclosure: The authors declare that they have no relevant financial interests.