Journal article
Distal Ureteral Diameter Ratio is Predictive of Breakthrough Febrile Urinary Tract Infection
The Journal of urology, Vol.198(6), pp.1418-1423
12/2017
DOI: 10.1016/j.juro.2017.06.095
PMID: 28694079
Abstract
Distal ureteral diameter ratio is an objective measure that is prognostic of spontaneous resolution of vesicoureteral reflux. Along with likelihood of resolution, improved identification of children at risk for recurrent febrile urinary tract infections may impact management decisions. We evaluated the usefulness of ureteral diameter ratio as a predictive factor for breakthrough febrile urinary tract infections.
Children with primary vesicoureteral reflux and detailed voiding cystourethrogram were identified. Ureteral diameter ratio was computed by measuring largest ureteral diameter within the pelvis and dividing by the distance between L1 and L3 vertebral bodies. Demographics, vesicoureteral reflux grade, laterality, presence/absence of bladder-bowel dysfunction, and ureteral diameter ratio were tested in univariate and multivariable analyses. Primary outcome was breakthrough febrile urinary tract infections.
We analyzed 112 girls and 28 boys with a mean ± SD age of 2.5 ± 2.3 years at diagnosis. Vesicoureteral reflux was grade 1 to 2 in 64 patients (45.7%), grade 3 in 50 (35.7%), grade 4 in 16 (11.4%) and grade 5 in 10 (7.2%). Mean ± SD followup was 3.2 ± 2.7 years. A total of 40 children (28.6%) experienced breakthrough febrile urinary tract infections. Ureteral diameter ratio was significantly greater in children with (0.36) vs without (0.25) breakthrough febrile infections (p = 0.004). Controlling for vesicoureteral reflux grade, every 0.1 U increase in ureteral diameter ratio resulted in 1.7 times increased odds of breakthrough infection (95% CI 1.24 to 2.26, p <0.0001).
Children with increased distal ureteral diameter ratio are at greater risk for breakthrough febrile urinary tract infections independent of reflux grade. Ureteral diameter ratio provides valuable prognostic information about risk of recurrent pyelonephritis and may assist with clinical decision-making.
Details
- Title: Subtitle
- Distal Ureteral Diameter Ratio is Predictive of Breakthrough Febrile Urinary Tract Infection
- Creators
- Angela M Arlen - Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IowaTraci Leong - Rollins School of Public Health, Emory University School of Medicine, Atlanta, GeorgiaP. Joseph Guidos - Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IowaSiobhan E Alexander - Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IowaChristopher S Cooper - Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- The Journal of urology, Vol.198(6), pp.1418-1423
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.juro.2017.06.095
- PMID
- 28694079
- ISSN
- 0022-5347
- eISSN
- 1527-3792
- Language
- English
- Date published
- 12/2017
- Academic Unit
- Stead Family Department of Pediatrics; Urology; Medicine Administration
- Record Identifier
- 9984051559102771
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