Distal ureteral diameter ratio (UDR) is an objective measure that is prognostic of spontaneous vesicoureteral reflux (VUR) resolution. Along with likelihood of resolution, improved identification of children at risk for recurrent febrile urinary tract infections (fUTI) may impact management decisions. We evaluated the utility of UDR as a predictive factor for breakthrough fUTI.
Children with primary VUR and detailed voiding cystourethrogram (VCUG) were identified. UDR was computed by measuring largest ureteral diameter within the pelvis and dividing by the distance between L1-L3 vertebral bodies. Demographics, VUR grade, laterality, presence/absence of bladder bowel dysfunction (BBD), and UDR were tested in univariate and multivariable analyses. Primary outcome was breakthrough fUTI.
One hundred and forty children (112 girls, 28 boys) were analyzed with a mean age at diagnosis of 2.5 ± 2.3 years. VUR was grade 1-2 (n = 64, 45.7%), grade 3 (n =50; 35.7%), grade 4 (16; 11.4%) and grade 5 (n = 10; 7.2%). Mean length of follow-up was 3.2 ± 2.7 years. Forty children (28.6%) experienced breakthrough fUTI events. Children with breakthrough fUTI had significantly higher UDR than those without (0.36 versus 0.25; p = 0.004). Controlling for VUR grade, every 0.1 unit increase in UDR resulted in 1.7 times increased odds of breakthrough infection (95% CI 1.24-2.26; p<0.0001).
Children with elevated distal ureteral diameter ratio are at increased risk for breakthrough fUTI independent of reflux grade. UDR provides valuable prognostic information about risk of recurrent pyelonephritis and may assist with clinical decision-making.
This research output has an Altmetric Attention Score of 6. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 21 December 2018.
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