妊娠期尿路感染相关因素及临床防治

目的了解妊娠期尿路感染的危险因素、主要病原菌及敏感抗生素,以提高诊治水平。方法选取2008年1月至2014年1月在我院住院的106例妊娠合并尿路感染患者,并选取产科门诊进行产前检查的无尿路感染的孕妇126例进行回顾性研究。结果年龄、孕周、糖尿病、既往尿路感染、泌尿系结石、贫血、流产是妊娠期尿路感染的高危因素,文化程度与妊娠期的尿路感染相关。妊娠期尿路感染病原菌以大肠埃希菌为主（占60．3％）。革兰阴性杆菌对青霉素类及喹诺酮类抗生素耐药率高,对头孢呋辛、头孢唑林、头孢他啶、头孢哌酮、头孢吡肟、亚胺培南、呋哺妥因敏感。革兰阳性球菌对半合成青霉素、喹诺酮类耐药率较高,对头孢呋辛、头孢唑林、头孢他啶、头孢哌酮、头孢吡肟、亚胺培南、呋喃妥因敏感。结论应注意妊娠期尿路感染的高危因素,加强孕期尿液检查及中段尿培养检查,选用敏感、合理的抗菌素治疗。     

Bacterial prostatitis caused by staphylococcus saprophyticus

Staphylococcus saprophyticus has been shown to be an important uropathogen in urinary tract infections in young women. Thirty-five isolates from 27 patients with staphylococci in the prostatic fluid of men with bacterial prostatitis were evaluated for the presence of S. saprophyticus. Three patients (11 per cent) with this organism were identified by novobiocin resistance (disk diffusion test), absence of hemolysis, and coagulase. These patients tended to be younger, more symptomatic, and more responsive to appropriate antibiotic therapy than those with Staphylococcus epidermidis. S. saprophyticus appears to be an important pathogen in prostatic infections.     

Statistical studies on bacteria isolated from urinary tract infections (report 4)

The statistics and drug sensitivity tests of bacterial florae isolated from the urinary tract in 1983 and 1984 were reviewed. Of the 2,222 strains isolated from outpatients, 593 (26.7%) were gram positive cocci, 21.4% were E. coli, 11.3% were Enterococcus, 10.4% were Proteus sp., 10.0% were P. aeruginosa, 5.6% were Alcaligenes sp., 4.2% were S. epidermidis and the rest were others. Of the 507 strains isolated from hospitalized patients, 107 (33.5%) were gram positive cocci, 20.3% were Enterococcus, 16.2% were P. aeruginosa, 9.1% were E. coli, 7.7% were Enterobacter sp. 7.5% were S. epidermidis, 4.9% were Proteus sp., S. marcescence and the rest were others. The percentage of E. coli, K. pneumoniae and S. epidermidis detected in the isolates from the outpatients and that of K. pneumoniae, Proteus sp. and S. epidermidis detected from the inpatients were lower than in previous reports. The percentage of P. aeruginosa and Enterococcus detected in the isolates from both groups of patients were higher than in previous reports. The major isolates (9 species) from the outpatients were more susceptible to the antimicrobial agents tested than those from the inpatients. The susceptibility of gentamicin, tetracycline and nalidixic acid to the major isolates was lower than in previous reports. During the past 2 years, we have been routinely using on inpatients the so-called new generation cefem antibiotics to treat urinary tract infections. This might be why the number of isolates of Enterococcus has increased especially in the isolates from inpatients.     

Streptococcus agalactiae as a urinary tract pathogen in males and non-pregnant females

The role ofStreptococcus agalactiae (group B streptococci, GBS) was investigated for a period of one year in different clinical forms of urinary tract infection in males and non-pregnant females over 14 years of age. The pathogen has been isolated in quantities of ≧10⁵ cfu/ml in midstream voided urine from 32 patients with clinical signs of urinary tract infection and pathologic urinary sediment. In every group of B isolates the antibiotic sensitivity to antimicrobial agents was determined by the single disk method of Kirby-Bauer. GBS with the same characteristics were established in urethral specimens of 4 males as well as in the vagina and faeces of 11 females. As a rule, peroral treatment with ampicillin proceeded successfully. In addition, women with streptococcal vaginitis were treated topically with 2% solution of chlorhexidine. Our results have demonstrated that GBS might cause urinary tract infection, but the evaluation of GBS isolated in urine specimens is complex.     

Species distribution and antibiotic sensitivity of bacteria isolated pre- and postoperatively from patients undergoing transurethral prostatic resection

The identity and antibiotic sensitivity of the isolated bacteria from 179 patients undergoing transurethral resection of the prostate were analysed. The patients were randomized into a group receiving a short course of cefotaxime in conjunction with the operation and a control group given no antibiotics. Preoperatively 70 patients had bacteriuria (greater than or equal to 10(7) CFU/l) with a predominance of Gram-negative bacteria (57 isolates, mainly Escherichia coli, Enterobacter, Klebsiella ssp, Proteus ssp), although Gram-positive species (24 isolates, mainly enterococci and Staphylococcus epidermidis) were also frequently encountered. Preoperatively isolated pathogens were evenly distributed in both groups and the sensitivity pattern was comparable. In the cefotaxime group postoperative recurrence of the preoperatively identified bacteria occurred in a lower frequency (11/43) than persistence in the control group (24/38). Only Gram-negative pathogens were isolated from patients with postoperative septicemia and upper urinary tract infections indicating that it is most important to direct prophylaxis against Gram-negative bacteria. A high degree of sensitivity against cefotaxime, gentamicin, trimethoprim, co-trimazine and a combination of ampicillin and mecillinam was recorded among both pre- and postoperatively isolated bacteria.     

Postoperative urinary tract infections (UTIs) following single-dose intraoperative antibiotic prophylaxis in colposuspension patients

The records of 196 women who underwent colposuspension for genuine stress incontinence at the Leicester General Hospital, England, between June 1991 and May 1996 were reviewed for evidence of urinary tract infection (UTI). Variables analyzed include age, type of anbibiotic, timing of a positive culture, organism(s) responsible and antibiotic sensitivity. Forty-six patients (23.47%) developed urinary infection; of these, 42 had received single-dose antibiotic prophylaxis with suprapubic catheterization. Thirty-two (76%) of those who developed UTI received augmentin (amoxycillin and clavulanic acid), whereas 10 (24%) were given cefuroxime and metronidazole. Positive cultures were obtained between postoperative days 3 and 28, with a mean of 9.6 days, and 81% occurred after the 7th day. Coliform organisms were responsible for nearly 70% of the infections. UTI is still common after colposuspension, despite single-dose antibiotic prophylaxis. Further studies looking at longer or alternative courses of antibiotics or clean intermittent self-catheterization are essential to establish the best way of curbing UTI in urogynecology patients.Editorial Comment: The authors present a summary of their experience with symptomatic urinary tract infection (UTI) after colposuspension, the patients having received a single dose of antibiotics preoperatively. Symptomatic urinary tract infections are described with regard to time of onset, length of suprapubic catheterization, pathogen and antibiotic sensitivity. One of the most interesting findings in this cohort of patients is the incidence of UTI over time, with the majority of infections occurring in the second postoperative week, and falling off dramatically thereafter. This is in contrast to the incidence of urinary tract infections with transurethral catheterization, where published experience suggests at 5%–10% increase in positive cultures for every day of transurethral catheterization, and almost universal positive cultures by 30 days. The results question the utility of preoperative single-dose antibiotic therapy in the prevention of UTI following colposuspension. Further investigation is needed to clarify what prophylactic antibiotic regimen is useful in preventing post-colposuspension infection of the lower urinary tract.     

Statistic studies on bacteria isolated from urinary tract infections (report 3)

The following results were obtained from the statistical studies and drug sensitivity tests of bacterial florae isolated from the urinary tract in 1981 and 1982. Of the 2,029 strains isolated from out-patients, 627 (30.9%) were gram positive cocci, 24.1% were E. coli, 9.4% were Proteus spp., 9.2% were Enterococci, 8.9% were S. epidermidis, 7.0 % were K. pneumoniae, 5.7% were P. aeruginosa and the rest were others. Of the 754 strains isolated from hospitalized patients, 276 (36.6%) were gram positive cocci, 16.8% were Enterococci, 11.4% were S. epidermidis, 11.1% were P. aeruginosa, 8.8% were Proteus spp, 7.2% were E.coli, 6.5% were K.pneumoniae and the rest were others. The number of Proteus spp., P. aeruginosa and Enterococci detected in the isolates from the out-patients and that of E.coli, K. pneumoniae and Proteus spp., detected in the isolates from the in-patients were smaller than in previous reports. More non-fermentative gram-negative bacilli and S. epidermidis were detected in the isolates from both patients were than in previous years. The major isolates i.e., 9 species, from out-patients were more susceptible to the antimicrobial agents tested. The susceptibility of TC and SBPC to major isolates was lower than in previous years. During the past two years, we have been routinely using on inpatients the so-called third generation cefem antibiotics to treat urinary tract infections. This might be why the number of isolates of gram positive cocci has increased especially isolates from inpatients.     

泌尿系疾病患者感染标本中大肠杆菌耐药性的检测

目的监测泌尿系疾病患者感染标本中大肠杆菌耐药状况，为临床用药提供参考。方法回顾性分析2003年1—12月泌尿外科住院患者感染标本中分离的32株大肠杆菌对常用抗生紊耐药性的检测结果，其中，菌株来自尿液20株、分泌物4株、脓液4株、引流液2株、血液和精液各1株。结果临床常用的22种抗生素中，耐药率〉50％者10种，占45％。四环素的敏感率为0，氨苄西林、哌拉西林和萘啶酸的敏感率〈10％。敏感率）80％者为阿米卡星、亚胺培南、头孢他啶、呋喃妥因、头孢哌酮、头孢吡肟共6种，未发现亚胺培南耐药菌株。结论泌尿系统感染致病菌中大肠杆菌的耐药性严重，其中以应用历史长、范围广的口服类抗生素的耐药性最为严重。     

Antibiotic prophylaxis following lower urinary tract instrumentation.

The value of routine antibiotic prophylaxis was assessed in 362 women undergoing lower urinary tract instrumentation. A three-day course of a once-a-day dose of 1 g of cefadroxil was compared with a three-day course of 100 mg of nitrofurantoin three times a day, in a randomized investigator blinded placebo controlled study. Both study drugs were significantly more effective in preventing postinstrumentation urinary tract infections than placebo (p less than 0.003). Differences in efficacy between the two test drugs were not significant; however, side effects in the nitrofurantoin group were more frequent and severe than those in the cefadroxil group. Cefadroxil also offered the advantage of a once-daily dosing schedule.     

Variable adherence of uropathogenic Escherichia coli to epithelial cells from women with recurrent urinary tract infection

The adherence of 74 Escherichia coli strains to vaginal and buccal epithelial cells from women with recurrent urinary tract infections was studied. The strains were isolated from the urine, vaginal introitus or anal mucosa of women with recurrent bacteriuria. Vaginal and anal isolates were judged to be associated with urinary tract infection if they had the same biotype and serotype as the strain isolated subsequently from the urine. Adherence levels of urinary and anal isolates, and vaginal isolates associated with urinary tract infection were similar for vaginal and buccal cells. Adherence of vaginal isolates not associated with urinary tract infection was significantly lower than adherence of urinary isolates for vaginal (p less than 0.001) and buccal (p less than 0.005) epithelial cells. A positive nonlinear correlation between vaginal and buccal adherence was observed for urinary (r equals 0.87, p less than 0.0001), vaginal (r equals 0.70, p less than 0.0005) and anal (r equals 0.32, p equals 0.047) isolates. Strains of O-serogroups commonly and less commonly associated with bacteriuria had similar adherence. The results suggest that adherence of vaginal isolates is associated with the ability to cause urinary tract infections. The strong correlation between vaginal and buccal cell receptivity suggests that susceptibility to such infections may be controlled by genotypic traits.     

Adhesiveness to urinary tract epithelial cells of fecal and urinary Escherichia coli isolates from patients with symptomatic urinary tract infections or asymptomatic bacteriuria of varying duration.

Adhesiveness to human urinary tract epithelial cells was high for Escherichia coli strains isolated from patients with acute pyelonephritis and acute cystitis, and low for asymptomatic bacteriuria strains detected at screening. Escherichia coli bacteria causing asymptomatic reinfections, detected near the onset of bacteriuria, adhered more than those detected at screening. No difference in the adhesive ability was found between fecal isolates of the strain causing urinary tract infection, isolated at or before onset of bacteriuria, and the urinary strain in symptomatic or asymptomatic patients. Normal fecal Escherichia coli from non-bacteriuric patients adhered less than all other strains tested.     

Current microbiological and clinical aspects of urinary tract infections.

OBJECTIVES: To evaluate some risk factors which could affect the isolation rates of various uropathogens and their in vitro susceptibility to antibiotics in ambulatory and hospitalized patients. PATIENTS AND METHODS: A prospective study was conducted in a microbiological laboratory at Pisa Hospital. Nine-hundred and seventy-two consecutive patients with documented urinary tract infection were enrolled from April 1996 to October 1999. Data on age, sex, current or previous bladder catheterization, some underlying diseases as diabetes mellitus, and previous antibiotic therapy were recorded. The distribution of bacteria isolates and their in vitro susceptibility to antibiotics was evaluated. RESULTS: Escherichia coli was responsible for 54.7% of urinary tract infections. Isolation of E. coli is decreasing in comparison to previous observations, especially in males and in patients with indwelling bladder catheters who instead show higher Pseudomonas spp. and Enterococcus spp. isolation rates than females and non-catheterized patients. Diabetes mellitus does not affect the isolation rate of uropathogens and their patterns of susceptibility. Multivariate analysis of multiresistant uropathogens showed a positive significant correlation with indewelling bladder catheter and age. An upward trend in the resistance of E. coli to cotrimoxazole, ampicillin and fluoroquinolones was observed from 1996 to 1999; more than 50% of Pseudomonas spp. strains were resistant to fluoroquinolones and gentamicin. CONCLUSIONS: The empirical antibiotic therapy of patients with urinary tract infection should be guided by an accurate anamnesis evaluating not only age and sex but also the presence of a bladder catheter at the moment of urine collection or a history of recent bladder catheterization and previous courses of antimicrobial drugs.     

Bacteremia following transurethral instrumentation. The predictive value of a serum bactericidal activity test

The bacteremic rate following transurethral instrumentation and the possibility of a serum bactericidal activity test to predict which patients that were at an increased risk of developing bacteremia was evaluated. Of 33 investigated patients, all elderly men, 14 underwent transurethral prostatic resection, 14 cystoscopy and 5 urethrotomy. None of the patients received prophylactic antibiotic treatment. The majority (97%) of the patients had bacteria isolated from the urinary tract before the instrumentation. Gram-positive cocci accounted for about two thirds (64%) and Gram-negative rods for about one third (31%) of all isolates. The most frequent species isolated were coagulase negative staphylococci (29%), Streptococcus faecalis (19%) and Klebsiella pneumoniae (12%). The bacteremic rate was 21%. None of the patients developed septicemia. Forty-four per cent of the patients with greater than or equal to 10(5) colony forming units/ml (cfu/ml) in urine developed bacteremia compared with 8% in patients with a sterile urine or less than 10(5) cfu/ml in urine (p less than 0.05). The urethral/prostatic flora was the source of bacteremia in at least one patient. Eighty-one per cent of the isolated strains were serum resistant. About half (54%) of the Gram-negative rods were more or less sensitive against actual, fresh patient serum. All Gram-positive cocci were resistant. There was no difference in the serum sensitivity between bacteria isolated from bacteremic patients and non-bacteremic patients. In conclusion, this study confirmed the relative high risk of developing bacteremia following transurethral instrumentation, especially if the urine is infected.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sensitivity of 99mtechnetium-dimercaptosuccinic acid for the diagnosis of chronic pyelonephritis: clinical and theoretical considerations

Radioisotopic renal imaging proved to be much more sensitive than excretory urography in diagnosing renal parenchymal damage in 6 children with acute febrile urinary tract infections. This increased sensitivity may affect clinical management. More importantly, it may change the interpretation of scientific studies evaluating the natural history and treatment of vesicoureteral reflux.     

Prevalence of antimicrobial resistance in intestinal flora of patients undergoing prostatic biopsy: implications for prophylaxis and treatment of infections after biopsy

Study Type – Prevalence (non‐consecutive cohort)
Level of Evidence 3b OBJECTIVE To determine the prevalence of antimicrobial resistance in intestinal flora of patients undergoing transrectal ultrasonography (TRUS)‐guided prostate biopsies (TGB) and to examine if this information is useful in selecting appropriate antimicrobial agents for prophylaxis and treatment of biopsy‐associated infections. PATIENTS AND METHODS In 2007 and 2008, rectal swabs were cultured from patients before undergoing TGB. Antimicrobial sensitivity of coliforms to amikacin, ciprofloxacin and coamoxiclav was determined. Laboratory records were used to identify patients who had bacteraemia or significant bacteriuria within 30 days of the TGB and the antimicrobial sensitivity pattern of these organisms were compared to those from the rectal swab. RESULTS Of 592 patients who had TGB, 445 (75.1%) had a rectal swab beforehand; 0.2%,10.6% and 13.3% of the coliforms were resistant to amikacin, ciprofloxacin and coamoxiclav, respectively. After TGB, six patients presented with urinary tract infections (UTI) and two with bacteraemia. All the infections were caused by coliforms except one UTI which was caused by ciprofloxacin‐sensitive Pseudomonas aeruginosa. The blood culture isolates were sensitive to amikacin but resistant to ciprofloxacin and coamoxiclav. All the coliforms in the urine were resistant to ciprofloxacin but sensitive to coamoxiclav. Urine isolates were not tested for amikacin sensitivity. There was a strong correlation between the antimicrobial sensitivity of the coliforms from the rectal swabs and those cultured from urine or blood in both patients for amikacin, six of eight for ciprofloxacin and seven of eight for coamoxiclav. CONCLUSIONS Our study shows that in the coliforms in the bowel flora of our local population there is a relatively high level of resistance to ciprofloxacin and coamoxiclav, and very low level of resistance to amikacin. As there was a strong correlation between the antimicrobial sensitivity of organisms causing infections after TGB and those isolated from the rectal swabs, we conclude that rectal swab cultures before TGB provide useful evidence for selecting appropriate antimicrobials for prophylaxis and treatment of TGB‐associated infections.     

CAGS and ACS Evidence Based Reviews In Surgery. 37: Is there a role for prophylactic antibiotics in the prevention of urinary tract infections following Foley catheter removal in patients having abdominal surgery?

Question: Does the use of antibiotic prophylaxis at urinary catheter removal reduce the rate of urinary tract infection? Design: Randomized controlled trial. Setting: Single centre in Basel, Switzerland. Patients: A total of 239 patients between January 2005 and September 2007 were randomly assigned into 2 groups by an online randomization generator. Intervention: Patients undergoing elective abdominal surgery with planned perioperative urethral catheterization were assigned at admission to receive either 960 mg of trimethoprim-sulfamethoxazole orally the night before and twice on the day of catheter removal or no antibiotic prophylaxis. Urinary cultures were obtained before and 3 days after catheter removal. Main outcome measures: Occurrence of symptomatic urinary tract infection (based on the Centers for Disease Control and Prevention definitions) after catheter removal. Results: Patients who received antibiotic pro-phylaxis experienced significantly fewer urinary tract infections than those who did not (5 of 103 [4.9%] v. 22 of 102 [21.6%], p < 0.001; number needed to treat 6). Patients who received antibiotic prophylaxis also had less significant bacteriuria 3 days after catheter removal than those who did not (17 of 103 [16.5%] v. 42 of 102 [41.2%], p < 0.001). Conclusion: Antibiotic prophylaxis with trimethoprim-sulfamethoxazole at the time of urinary catheter removal significantly reduces the rate of symptomatic urinary tract infections and bacteriuria in patients who undergo abdominal surgery and perioperatively receive transurethral urinary catheters.     

966株尿路感染病原菌的分布

目的分析尿路感染的病原菌分布及耐药性特点,为临床选用抗菌药物提供依据。方法采用VITEK-32细菌鉴定仪鉴定菌种,对尿路感染患者的1978份尿液标本中分离的966株泌尿系感染病原菌进行鉴定及药物敏感试验。结果在分离的966株病原菌中,革兰阴性菌675株（占69．9％）,主要为大肠埃希菌;革兰阳性菌183株（占18．9％）,主要为粪肠球菌;真菌108株（占11．2％）,主要为白色念珠菌。分离数在前5位的病原菌依次为大肠埃希菌（占49．0％）、粪肠球菌（占9．6％）、肺炎克雷伯菌（占7．ooA）、白色念珠菌（占6．8％）、奇异变形杆菌（占3．9％）。大肠埃希菌产超广谱争内酰胺酶（ESBLs）检出率为47．3％,肺炎克雷伯菌产ESBLs检出率为33．8％。甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率为44．8％,耐甲氧西林金黄色葡萄球菌（MRSA）的检出率为50％。结论引起尿路感染病原菌的分布广泛,大肠埃希菌为尿路感染的主要病原菌。有些菌株产生多重耐药性,大肠埃希菌产ESBLs检出率较高。应尽量根据药物敏感试验选用抗菌药物,减少耐药菌株的产生和医院感染的爆发流行。     

Symptoms of interstitial cystitis, painful bladder syndrome and similar diseases in women: a systematic review

PURPOSE: In women symptoms of interstitial cystitis are difficult to distinguish from those of painful bladder syndrome and they appear to overlap with those of urinary tract infection, chronic urethral syndrome, overactive bladder, vulvodynia and endometriosis. This has led to difficulties in formulating a case definition for interstitial cystitis, and complications in the treatment and evaluation of its impact on the lives of women. We performed a systematic literature review to determine how best to distinguish interstitial cystitis from related conditions. MATERIALS AND METHODS: We performed comprehensive literature searches using the terms diagnosis, and each of interstitial cystitis, painful bladder syndrome, urinary tract infection, overactive bladder, chronic urethral syndrome, vulvodynia and endometriosis. RESULTS: Of 2,680 screened titles 604 articles were read in full. The most commonly reported interstitial cystitis symptoms were bladder/pelvic pain, urgency, frequency and nocturia. Interstitial cystitis and painful bladder syndrome share the same cluster of symptoms. Chronic urethral syndrome is an outdated term. Self-reports regarding symptoms and effective antibiotic use can distinguish recurrent urinary tract infections from interstitial cystitis in some but not all women. Urine cultures may also be necessary. Pain distinguishes interstitial cystitis from overactive bladder and vulvar pain may distinguish vulvodynia from interstitial cystitis. Dysmenorrhea distinguishes endometriosis from interstitial cystitis, although many women have endometriosis plus interstitial cystitis. CONCLUSIONS: In terms of symptoms interstitial cystitis and painful bladder syndrome may be the same entity. Recurrent urinary tract infections may be distinguished from interstitial cystitis and painful bladder syndrome via a combination of self-report and urine culture information. Interstitial cystitis and painful bladder syndrome may be distinguished from overactive bladder, vulvodynia and endometriosis, although identifying interstitial cystitis and painful bladder syndrome in women with more than 1 of these diseases may be difficult.     

An investigation into the sensitivities of translocating bacteria to a prophylactic antibiotic regimen

INTRODUCTION: It is well established that bacterial translocation is associated with a significant increase in septic morbidity. The purpose of this study was to determine the antibiotic sensitivities of translocating bacteria on the basis that this information may influence antibiotic prophylaxis in surgical patients. METHODS: Routine microbiological techniques were used to assess the antibiotic sensitivities of those bacteria cultured from a mesenteric lymph node harvested at laparotomy in a large series of patients. RESULTS: Culture of the mesenteric lymph nodes yielded growth in 51 out of a total of 447 patients studied (11.4%). The isolates from 40 patients, a total of 60 organisms, were available for sensitivity testing. The most common species grown was Escherichia coli (48% of isolates). Thirty-three patients (83%) grew organisms sensitive to the antibiotic prophylaxis used, but there was no significant difference in the incidence of postoperative septic complications between these patients and those in whom resistant bacteria were grown (39% versus 29%, P = 0.64 Fisher's Exact test mid P). CONCLUSIONS: The majority of translocating bacteria are sensitive to the prophylactic antibiotics commonly used in patients undergoing laparotomy. However, the occurrence of postoperative septic morbidity is independent of this variable.     

Is endoscopic decompression of the neonatal extravesical upper pole ureterocele necessary for prevention of urinary tract infections or bladder neck obstruction?

PURPOSE: It has been hypothesized that endoscopic decompression of the duplex extravesical ureterocele is necessary to prevent the complications of urinary tract infections and progressive hydronephrosis. This study was performed to test this premise. MATERIALS AND METHODS: Infants younger than 2 weeks with an extravesical ureterocele associated with a duplex upper pole moiety were assigned to immediate endoscopic puncture of the ureterocele followed by antibiotic prophylaxis or antibiotic prophylaxis with plans for delayed surgical intervention. Radiographic studies and catheterized urine cultures were obtained at ages 3 and 6 months and for fever greater than 38.5C. All patients included in this study were followed through 6 months of life. RESULTS: Of the patients 32 underwent endoscopic puncture of the ureterocele. Median patient age at endoscopy was 5 days (range 3 to 13). During the first 6 months of life complications developed in 4 (12%), including febrile urinary tract infections in 3 (9%) and with progressive hydronephrosis due to incomplete puncture of the ureterocele in 1 (3%). The remaining 40 patients were treated with antibiotic prophylaxis and delayed open surgery. Median time to open surgery was 3 months (range 2 to 6). During the first 6 months of life complications developed in 5 (13%), including 3 (8%) febrile urinary tract infections and progressive hydronephrosis in 2 (5%). No statistical difference was noted between the 2 treatment groups. CONCLUSIONS: In patients with extravesical duplex ureteroceles neonatal complications of urinary tract infection and progressive hydronephrosis are not significantly different between those treated with immediate endoscopic decompression versus delayed open surgical intervention.