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Updated: Apr 17, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Can distal ureteral diameter predict reflux resolution after endoscopic injection?
Tamer Helmy1, Doaa Sharaf1, Ahmed AbdelHalim1
1Pediatric Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Insights
The ureteral diameter ratio (UDR) can predict successful endoscopic treatment for primary vesicoureteral reflux (VUR) in children. This objective measurement aids in determining treatment outcomes for VUR.
Area of Science:
- Pediatric Urology
- Medical Imaging
- Surgical Outcomes
Background:
- Primary vesicoureteral reflux (VUR) is common in children.
- Endoscopic injection is a standard VUR treatment.
- Predicting treatment success is crucial for patient management.
Purpose of the Study:
- To evaluate the predictive value of distal ureteral diameter (UD) for reflux resolution after endoscopic injection in children with primary VUR.
- To establish an objective measurement for predicting treatment success.
Main Methods:
- Retrospective review of 70 children with primary VUR treated with endoscopic injection (2009-2012).
- Measurement of distal UD and calculation of the UD ratio (UDR) from voiding cystourethrograms.
- Logistic regression analysis to assess UD and UDR as predictors of reflux resolution.
Main Results:
- UD and UDR were significant predictors of reflux resolution (P < .007 and P = .001, respectively).
- Mean UD was 5.5 mm and mean UDR was 37.8%.
- No postoperative complications were observed.
Conclusions:
- The ureteral diameter ratio (UDR) offers an objective metric for VUR.
- UDR serves as a valuable predictive tool for the success of endoscopic injection therapy in pediatric VUR.
Objective:
To test the predictive value of distal ureteral diameter (UD) on reflux resolution after endoscopic injection in children with primary vesicoureteral reflux (VUR).
Materials And Methods:
This was a retrospective review of patients diagnosed with primary VUR between 2009 and 2012 who were managed by endoscopic injection. Seventy preoperative and postoperative voiding cystourethrograms were reviewed. The largest UD within the false pelvis was measured. The UD was divided by the L1-L3 vertebral body distance to get the UD ratio (UDR). One radiologist interpreted the findings of voiding cystourethrography in all patients. Clinical outcome was defined as reflux resolution.
Results:
Seventy patients were enrolled in this series (17 boys and 53 girls). Mean age was 5.9 years (1.2-13 years). Grade III presented in 37 patients (53%), and 33 patients (47%) were of grade IV. Mean distal UD was 5.5 mm (2.5-13 mm). Mean UDR was 37.8% (18%-70%). Macroplastique injection was performed in all. Subureteric injection was performed in 60 patients (86%), whereas intraureteric injection was performed in 10 patients. No postoperative complications were detected. The effect of grade, UD, and UDR on success after endoscopic injection was tested. UD and UDR were significant predictors of reflux resolution on logistic regression analysis (P <.007 and .001, respectively).
Conclusion:
UDR provides an objective measurement of VUR and appears as a predictive tool of success after endoscopic injection.
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