Ureteral diameter ratio helps determine outcomes in vesicoureteral reflux patients

The ureteral diameter ratio (UDR) is an accurate measurement of vesicoureteral reflux (VUR) and may be used to determine clinical outcome and success of endoscopic injection, a recent study has shown.

Researchers conducted a retrospective review of 383 patients (median age, 5 years; 256 females) undergoing treatment for primary VUR. UDR was calculated during the initial voiding cystourethrography. Other information retrieved included demographic factors, clinical course, bladder-bowel dysfunction, dimercaptosuccinic acid scintigraphy findings and other complaints upon admission.

UDR was significantly correlated with the degree of reflux (p=0.0001). Majority of the participants (n=321; 83.8 percent) required surgical treatment while 62 (16.2 percent) experienced spontaneous resolution. UDR was significantly lower in the latter group (p<0.005). Each 0.05-unit increase in UDR correlated with lower odds of spontaneous resolution.

Moreover, compared to reflux grade, UDR was found to be significantly more predictive of spontaneous VUR resolution, according to multivariate logistic regression analysis.

In the surgery group, majority (77.3 percent; n=248) received endoscopic injections. UDR was significantly higher in those whose injections were unsuccessful (p<0.005), such that each 0.05-unit increase in UDR resulted in a higher likelihood of failure.

“Primary VUR is a congenital anomaly of the vesicoureteral junction resulting in a shortened ureteral tunnel and poor detrusor backing of the ureter with potentially serious consequences such as recurrent urinary tract infection and renal parenchymal scars, which in the long run can lead to renal failure,” said researchers.

“[T]he distal ureteral diameter ratio seems to be an objective measurement method in the clinical follow-up of patients with primary VUR,” they added. “It is a new parameter that will be useful in predicting which patients will show spontaneous regression or the success of endoscopic injection therapy.”