Journal article
The impact of the distal ureteral diameter ratio, bladder volume at onset of vesicoureteral reflux, and/or grade in predictive models of clinical outcomes in children with vesicoureteral reflux
Journal of pediatric urology, Vol.20(4), pp.750.e1-750.e7
08/2024
DOI: 10.1016/j.jpurol.2024.05.027
PMID: 38871546
Abstract
Vesicoureteral reflux (VUR) grade has been used as a primary factor in assessing a child's risk of clinical outcomes. Unfortunately, grade has poor inter-observer reliability. We hypothesized that more objective and reliable VCUG parameters including the distal ureteral diameter ratio (UDR) and volume at onset of VUR (Vol) may either augment or replace the current grading system to provide more reliable prediction of clinical outcomes.
Multivariate clinical outcome models were analyzed to assess the impact on predictive accuracy by the addition of voiding cystourethrogram (VCUG) data including grade, UDR, and Vol, alone or in combinations. Clinical variables from retrospective review of 841 children's records included age, gender, presentation, VUR laterality, bowel and bladder dysfunction, history of febrile urinary tract infection (UTI), and number of UTIs. The primary outcomes assessed included VUR resolution or persistence and need for operative intervention.
Grade, UDR, and Vol were independent predictors of resolution and operative intervention. Vol increased predictive accuracy in resolution models with grade or UDR alone; however, no significant difference occurred in models with the substitution of grade with UDR.
A more reliable classification system for VUR, with improved predictive accuracy regarding clinical outcomes, may be developed incorporating UDR and Vol. Whether VUR grade can be completely replaced by Vol and UDR measurements requires further evaluation with larger number of patients.Summary tableSummary of impact of grade, Vol, and UDR alone or in combination on predictive accuracy of multivariate models relative to clinical outcomes.Summary tableClinical outcomeSignificance of GR, Vol,UDR on predictive accuracyImpact of combination of GR, Vol,UDR on predictive accuracySpontaneous ResolutionGR, Vol, UDR each significantGR + Vol > GR or Vol aloneUDR + Vol > Vol aloneGR = UDR = GR + UDRaVol + UDR = Vol + GR = GR + UDRaOperative InterventionGR, Vol, UDR each significantNot assessed due to a small number of patients with UDR measurements undergoing operative interventionGR = grade.Vol = bladder volume at onset of VUR as a percent of age predicted bladder capacity.UDR = ureteral diameter ratio.aNo significant difference demonstrated in these three models.
Details
- Title: Subtitle
- The impact of the distal ureteral diameter ratio, bladder volume at onset of vesicoureteral reflux, and/or grade in predictive models of clinical outcomes in children with vesicoureteral reflux
- Creators
- Christopher S. Cooper - University of Iowa Hospitals and ClinicsJoanna A. Orzel - University of IowaMegan A. Bonnett - University of IowaM. Bridget Zimmerman - University of IowaJohnny R. Malicoat - University of IowaArman C. Hlas - University of IowaDouglas W. Storm - Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA, 52242-1089, USAGina M. Lockwood - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of pediatric urology, Vol.20(4), pp.750.e1-750.e7
- DOI
- 10.1016/j.jpurol.2024.05.027
- PMID
- 38871546
- NLM abbreviation
- J Pediatr Urol
- ISSN
- 1477-5131
- eISSN
- 1873-4898
- Publisher
- Elsevier Ltd
- Grant note
Funding for this project was provided in part through the endowed Tyrone D. Artz Chair in Pediatric Urology.
- Language
- English
- Electronic publication date
- 06/01/2024
- Date published
- 08/2024
- Academic Unit
- Microbiology and Immunology; Stead Family Department of Pediatrics; Biostatistics; Orthopedics and Rehabilitation; Urology; Medicine Administration
- Record Identifier
- 9984643758902771
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