Differences in diagnostic strategies in asymptomatic unilateral congenitalhydronephrosis

Background: Routine sonographic screening results in an increasing number o f neonates diagnosed with asymptomatic congenital hydronephrosis. Clinical relevance of this finding is difficult to assess, as congenital hydronephro sis can be a symptom of various severe pathologies of the urinary tract, bu t also a normal variant. There is no general consensus regarding the diagno stic procedures in these neonates. Method: In order to investigate different diagnostic strategies for asympto matic unilateral congenital hydronephrosis, a questionnaire was designed an d 75% of the pediatric departments in four federal states in eastern Austri a were interviewed. Results: Whereas there were clear diagnostic strategies for severe hydronep hrosis, less extreme but more frequent findings resulted in markedly diverg ent indications and timing of diagnostic procedures. This was particularly evident with regard to classification of ultrasound findings, indication fo r voiding-cystourethrogram and initiation of antibiotic prophylaxis. A chil d which would be observed clinically for months in one center might be imme diately operated on in another. Conclusion: In all interviews, the need of a general consensus on diagnosti c strategies for asymptomatic unilateral congenital hydronephrosis became a pparent.