SPU Main Site  |  Past and Future Meetings
Society For Pediatric Urology

Back to 2020 Abstracts


Objective Measure of Vesicoureteral Reflux Over Time: Resolution Curves Based on Ureteral Diameter Ratio
Angela M. Arlen1, Traci Leong2, Andrew J. Kirsch2, Christopher S. Cooper3
1Yale University, New Haven, CT, 2Children's Healthcare of Atlanta, Atlanta, GA, 3University of Iowa Hospitals and Clinics, Iowa City, IA

Introduction
Known factors impacting spontaneous resolution of vesicoureteral reflux (VUR) include grade, age, laterality, presence of bladder and bowel dysfunction, renal scarring, distal ureteral dilation, and bladder volume at which reflux occurs. Distal ureteral diameter ratio (UDR) is an objective measure reflective of ureterovesical junction anatomy independently predicts both spontaneous resolution and breakthrough urinary tract infections in children. Using patients from multiple institutions, we created resolution curves based on UDR, controlling for age at diagnosis and laterality.

Methods
Voiding cystourethrograms diagnosing primary VUR were reviewed. UDR was calculated by measuring largest ureteral diameter within the pelvis and dividing by the distance between the L1-L3 vertebral bodies. Resolution curves based UDR were created, controlling for grade, laterality and patient age. Time to resolution was calculated censoring children with persistent VUR and those who underwent surgery. Patient demographics and imaging indication were also assessed.

Results
Three hundred and four patients (226 females, 78 males) were analyzed with a mean age at diagnosis of 1.55 ± 1.98 years and followed over time. Mean maximum VUR grade was 2.9 ± 1 and mean UDR was 0.28 ± 0.17. As expected, unilateral reflux (p = 0.02), VUR grades 1-3 (p<0.001), and lower UDR (p<0.001) were associated with spontaneous resolution on univariate analysis. Using Kaplan Meier curves, median time to spontaneous resolution in years was calculated at various cutoffs [Table]. Patients with a UDR of <0.1 had 1.7 times the chance of resolution compared to those with =0.1 (95% CI 0.94-3.13). Similarly, those with a UDR of <0.3 were 5.7 times more likely to resolve than those with UDR =0.3 (95% CI 2.96-10.82) [Figure].

Conclusions
Children with primary VUR and higher UDR are less likely to spontaneously resolve over time, regardless of other factors. UDR provides valuable, objective prognostic information regarding projected clinical course, facilitating individualized patient management.


Back to 2020 Abstracts