Validation of the ureteral diameter ratio for predicting early spontaneous resolution of primary vesicoureteral reflux

Arlen, Angela M.; Kirsch, Andrew J.; Leong, Traci; Cooper, Christopher S.

doi:10.1016/j.jpurol.2017.01.012

Cited by 30 publications

(13 citation statements)

References 29 publications

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“…[15] Our data suggested that evaluation of ureteral dilatation using MRI is applicable to predict concurrent VUR, especially high-grade VUR whose surgical treatments occasionally were required. A recent study reported the association between ureteral dilatation measured by VCUG and the severity of VUR,[19] and this result might support our findings.…”

Section: Discussionsupporting

confidence: 92%

Ureteral dilatation detected in magnetic resonance imaging predicts vesicoureteral reflux in children with urinary tract infection

et al. 2018

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ObjectiveUrinary tract infection (UTI), one of the most common bacterial infections occurring during infancy and early childhood, is frequently associated with vesicoureteral reflux (VUR). Although several guidelines recommend performing ultrasonography as a screening test, its utility is not adequate and appropriate screening tests are strongly desirable. In this study, we evaluate the use of magnetic resonance imaging (MRI) as a screening test for VUR in children with UTI.MethodsWe prospectively studied 108 patients with suspected UTI between April 2014 and March 2016. UTI was diagnosed on the basis of diffusion-weighted MRI (DW-MRI) and urine culture findings. We measured ureteral dilatation using MRI in 96 patients with UTI and assessed the relationship between ureteral dilatation in MRI and VUR in 46 patients who underwent voiding cystourethrography (VCUG).ResultsAmong 108 patients, 88 and 8 were diagnosed with upper and lower UTI, respectively. Among 46 patients who underwent VCUG, 23 had VUR (14 low grade and 9 high grade). Patients with ureteral dilatation detected on MRI had VUR more frequently than those without ureteral dilatation (any grades VUR, 71% vs. 32%; P = 0.02; high-grade VUR, 38% vs. 2%, P = 0.007). Overall, ureteral dilatation findings on MRI achieved sensitivity 65.2% and specificity 73.9% as a screening test for VUR. In addition, DW-MRI achieved sensitivity 100% and specificity 81.8% in the diagnosis of upper UTI.ConclusionThese findings suggested that MRI is a valuable tool for screening of VUR as well as diagnosis of upper UTI.

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Section: Discussionsupporting

confidence: 92%

Ureteral dilatation detected in magnetic resonance imaging predicts vesicoureteral reflux in children with urinary tract infection

et al. 2018

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“…Since the average of the ureteral diameter does not exceed than 0.5 cm, it can be concluded that the grade of the potential Vesicoureteric reflux (VUR) can be between 1 and 2. This means that the reflux can be limited to the ureter and up to the renal pelvis [37].…”

Section: Simulation Of a Healthy Ureteral Contractionmentioning

confidence: 99%

A computational model of ureteral peristalsis and an investigation into ureteral reflux

Hosseini

et al. 2017

Biomed. Eng. Lett.

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The aim of this study is to create a computational model of the human ureteral system that accurately replicates the peristaltic movement of the ureter for a variety of physiological and pathological functions. The objectives of this research are met using our in-house fluidstructural dynamics code (CgLes-Y code). A realistic peristaltic motion of the ureter is modelled using a novel piecewise linear force model. The urodynamic responses are investigated under two conditions of a healthy and a depressed contraction force. A ureteral pressure during the contraction shows a very good agreement with corresponding clinical data. The results also show a dependency of the wall shear stresses on the contraction velocity and it confirms the presence of a high shear stress at the proximal part of the ureter. Additionally, it is shown that an inefficient lumen contraction can increase the possibility of a continuous reflux during the propagation of peristalsis.

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“…Furthermore, UDR proved more able to predict spontaneous resolution, persistence or requirement for operative intervention than the VUR Grading System . The mean UDR of patients with spontaneous resolution of VUR was significantly lower than in persistent reflux and patients who underwent surgery ( P < 0.001) . Prediction models of recurrent breakthrough UTIs within 2 years would help clinicians and parents to determine optimal management of VUR …”

Section: Are There Any Alternatives To Vcug?mentioning

confidence: 99%

“…167 The mean UDR of patients with spontaneous resolution of VUR was significantly lower than in persistent reflux and patients who underwent surgery (P < 0.001). 168 Prediction models of recurrent breakthrough UTIs within 2 years would help clinicians and parents to determine optimal management of VUR. 169 How to detect occult VUR Positioning the instillation of contrast cystography was proposed in order to detect occult VUR that conventional VCUG cannot prove.…”

Section: Prediction Of Vur Resolutionmentioning

confidence: 99%

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

et al. 2018

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Voiding cystourethrography is the most important fluoroscopic examination in pediatric urology for the investigation of lower urogenital tract diseases, such as vesicoureteral reflux or urethral stricture. However, this invasive procedure imposes a significant burden on children and their parents, and recently there has been a paradigm shift in the diagnosis and treatment of vesicoureteral reflux. In the 2011 revision, the American Academy of Pediatrics guidelines on urinary tract infection recommended abandoning routine voiding cystourethrography after the first febrile urinary tract infection. In 2014, the randomized intervention for children with vesicoureteral reflux study recommended discontinuation of routine continuous antibiotic prophylaxis for vesicoureteral reflux. The time is now ripe to radically reconsider indications for voiding cystourethrography and the procedure itself.

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Validation of the ureteral diameter ratio for predicting early spontaneous resolution of primary vesicoureteral reflux

Abstract: UDR correlates with reflux grade, and is predictive of early resolution in children with primary VUR. UDR is an objective measurement of VUR, and provides valuable prognostic information about spontaneous resolution, facilitating more individualized patient care.

Cited by 30 publications

References 29 publications

Ureteral dilatation detected in magnetic resonance imaging predicts vesicoureteral reflux in children with urinary tract infection

Ureteral dilatation detected in magnetic resonance imaging predicts vesicoureteral reflux in children with urinary tract infection

A computational model of ureteral peristalsis and an investigation into ureteral reflux

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

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