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Asian Journal of Urology, 2024, 11(3): 437-442    doi: 10.1016/j.ajur.2023.05.007
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An evaluation of ureteral diameter ratio and vesicoureteral reflux index in the treatment of primary vesicoureteral reflux
Yusuf Atakan Baltrak*(),Nebil Akdoğan,Mutlu Değer,Volkan Izol,Ibrahim Atilla Aridoğan,Nihat Satar
Division Pediatric Urology, Department of Urology, Medical Faculty, Cukurova University, Adana, Turkey
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Abstract: 

Objective: Vesicoureteral reflux (VUR) index is a simple, validated tool that reliably predicts significant improvement and spontaneous resolution of primary reflux in children. The aim of this study was to evaluate and compare the ureter diameter ratio (UDR) and VUR index (VURx) of patients treated with endoscopic injection (EI) and ureteroneocystostomy (UNC) methods in the pediatric age group due to primary VUR.

Methods: Patients under the age of 18 years old who underwent EI and UNC with the diagnosis of primary VUR between January 2011 and September 2021 were determined as the participants. The UDR was assessed using voiding cystourethrography, and the VURx score was determined prior to treatment based on hospital records included in the study.

Results: A total of 255 patients, 60 (23.5%) boys and 195 (76.5%) girls, with a mean age of 76.5 (range 13.0-204.0) months, were included in the study. EI was applied to 130 (51.0%) patients and UNC was applied to 125 (49.0%) patients due to primary VUR. The optimum cut-off for the distal UDR was obtained as 0.17 with sensitivity and specificity of 73.0% and 63.0%, respectively. The positive and negative predictive values were 66.0% and 70.0%, respectively.

Conclusion: When the UDR and VURx score are evaluated together for the surgical treatment of primary VUR in the pediatric age group, it is thought that it may be useful in predicting the clinical course of the disease and evaluating surgical treatment options.

Key words:  Distal ureter diameter ratio    Vesicoureteral reflux    Vesicoureteral reflux index management    Vesicoureteral reflux index
收稿日期:  2022-07-16           接受日期:  2023-05-15      出版日期:  2024-07-20      发布日期:  2024-08-13      整期出版日期:  2024-07-20
引用本文:    
. [J]. Asian Journal of Urology, 2024, 11(3): 437-442.
Yusuf Atakan Baltrak, Nebil Akdoğan, Mutlu Değer, Volkan Izol, Ibrahim Atilla Aridoğan, Nihat Satar. An evaluation of ureteral diameter ratio and vesicoureteral reflux index in the treatment of primary vesicoureteral reflux. Asian Journal of Urology, 2024, 11(3): 437-442.
链接本文:  
http://www.ajurology.com/CN/10.1016/j.ajur.2023.05.007  或          http://www.ajurology.com/CN/Y2024/V11/I3/437
Variable Score
Gender
Girl 1
Boy 0
VUR timing
Early-moderate filling 3
Late filling 2
Voiding phase 1
Ureteral abnormality
Yes 1
No 0
VUR incidence
Grades I-III 0
Grades IV-V 1
  
Variable EI (n=130) UNC (n=125) p-Value
Age, month 68.0 (13.0-190.0) 72.0 (25.0-204.0) 0.835
Distribution age 0.801
≤24 months 18 (13.8) 0
>24 months 112 (86.2) 125 (100.0)
Height, cm 116.1±21.5 112.5±22.5 0.191
Weight, kg 28.5±12.9 24.6±11.9 0.120
BMI, kg/m2 20.07 (11.11-21.67) 16.64 (12.10-19.67) 0.175
Gender 0.110
Boy 36 (27.7) 24 (19.2)
Girl 94 (72.3) 101 (80.8)
Hemoglobin, g/dL 11.9±1.3 12.2±1.5 0.139
Blood urea nitrogen, mg/dL 12.9±8.1 14.2±8.2 0.160
Blood creatinine, mg/dL 0.5±0.5 0.5±0.4 0.958
Renal scarring incidence 0.428
No 73 (56.2) 64 (51.2)
Yes 57 (43.8) 61 (48.8)
Kidney function distribution, %
Right kidney 51.6±20.1 49.6±21.3 0.610
Left kidney 48.4±20.1 50.1±21.2 0.748
  
Variable EI (n=130) UNC (n=125) p-Value
Location <0.001
Right 36 (27.7) 15 (12.0)
Left 54 (41.5) 26 (20.8)
Bilateral 40 (30.8) 84 (67.2)
Bilateral reflux <0.001
No 90 (69.2) 41 (32.8)
Yes 40 (30.8) 84 (67.2)
Constipation 0.093
No 107 (82.3) 92 (73.6)
Yes 23 (17.7) 33 (26.4)
Urinary incontinencea <0.001
No 96 (75.0) 33 (26.8)
Yes 32 (25.0) 90 (73.2)
Reflux incidence <0.001
Low-grade 88 (67.7) 57 (45.6)
High-grade 42 (32.3) 68 (54.4)
Reflux time 0.138
Voiding phase 73 (56.2) 55 (44.0)
Filling phase 57 (43.8) 70 (56.0)
  
Variable EI UNC
Grades I-III Grades IV-V p-Value Grades I-III Grades IV-V p-Value
VURx score 2.4±0.7 3.5±0.7 <0.001 2.6±0.7 3.9±0.7 <0.001
UDR 0.14±0.06 0.21±0.09 <0.001 0.19±0.09 0.26±0.08 <0.001
UDR <0.001 <0.001
<0.17 67 (76.1) 14 (33.3) 27 (47.4) 7 (10.3)
≥0.17 21 (23.9) 28 (66.7) 30 (52.6) 61 (89.7)
  
Variable OR (95% CI) p-Value
Age (>24 months) 0.99 (0.37-2.64) 0.981
Gender (girl) 2.09 (0.87-5.03) 0.099
Bilateral reflux 4.90 (2.45-9.79) <0.001
Urinary incontinence 8.88 (4.45-17.76) <0.001
UDR (≥0.17) 5.53 (2.62-11.66) <0.001
VUR (high-grade) 1.67 (0.73-3.81) 0.223
Constipation 1.06 (0.46-2.45) 0.888
Reflux time (filling) 0.51 (0.23-1.14) 0.100
  
  
  
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