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Updated: Mar 20, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
VUR timing on VCUG as a predictive factor of VUR resolution after endoscopic therapy
Jun Nyung Lee1, So Mi Lee2, Yun-Sok Ha1
1Department of Urology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Insights
Vesicoureteral reflux (VUR) timing on voiding cystourethrogram (VCUG) predicts success in endoscopic therapy for primary VUR in children. Voiding reflux shows higher success rates than filling reflux, identifying VUR timing as a new predictive factor.
Area of Science:
- Pediatric Urology
- Endourology
- Medical Imaging
Background:
- Vesicoureteral reflux (VUR) timing on voiding cystourethrogram (VCUG) is a known predictor of spontaneous resolution in children.
- Filling reflux is associated with lower spontaneous resolution rates and higher likelihood of requiring surgical intervention compared to voiding reflux.
- The prognostic value of VUR timing for endoscopic therapy in primary VUR has not been previously established.
Purpose of the Study:
- To evaluate the impact of VUR timing (filling vs. voiding reflux) on the success rates of endoscopic therapy for primary VUR in children.
- To identify VUR timing as a potential prognostic factor for surgical outcomes following endoscopic treatment.
Main Methods:
- Retrospective review of 94 primary VUR patients undergoing initial endoscopic injection therapy.
- Patients categorized into filling or voiding reflux groups based on preoperative VCUG.
- Radiologic success defined as VUR grade I or less on VCUG at 3-6 months post-therapy; multivariate logistic regression used for analysis.
Main Results:
- The filling reflux group (68 patients/101 ureters) had significantly higher preoperative VUR grades than the voiding reflux group (26 patients/35 ureters).
- Radiologic success rates were significantly lower in the filling reflux group (56.44%) compared to the voiding reflux group (88.57%).
- Multivariate analysis confirmed both VUR grade and VUR timing as significant independent predictors of radiologic success (p<0.001 and p=0.005, respectively).
Conclusions:
- VUR timing on preoperative VCUG is a significant and independent predictor of success for endoscopic therapy in primary VUR.
- Patients with voiding reflux demonstrate higher success rates after endoscopic injection compared to those with filling reflux.
- This study identifies VUR timing as a novel prognostic factor, alongside VUR grade, for optimizing endoscopic treatment outcomes in pediatric VUR.
Background:
The timing of reflux onset on VCUG (VUR timing) has been considered a predictive factor of spontaneous resolution in VUR children. While the voiding reflux is associated with a greater rate of spontaneous resolution, the filling reflux is more likely to require surgical intervention. However, the VUR timing in children with primary VUR has not been evaluated with regard to the prognostic value of endoscopic therapy. The aim of this study was to evaluate the effect of VUR timing on the surgical outcome after endoscopic therapy for primary VUR.
Method:
We retrospectively reviewed the medical records of 94 primary VUR patients who underwent endoscopic injection for their initial surgical management. Radiologic success was defined as grade I or less on VCUG at 3-6 months following endoscopic therapy. We allocated patients to a filling reflux group or a voiding reflux group on the basis of their most recent preoperative VCUG. We evaluated the patients' demographics and outcomes after endoscopic therapy according to VUR timing. Predictive factors for radiologic success were analyzed using a multivariate logistic regression model.
Results:
Of the 94 children (136 ureters), 68 (101 ureters) were classified as the filling reflux group and 26 (35 ureters) were placed in the voiding reflux group. The preoperative VUR grade in the filling reflux group was significantly higher than that in the voiding reflux group (p = 0.001). Radiologic success was observed in 56.44% (57/101 ureters) in the filling reflux group and in 88.57% (31/35 ureters) in the voiding reflux group (p = 0.001). Multivariate analysis showed that VUR grade and VUR timing on VCUG were predictive factors of radiologic success after endoscopic therapy (p = 0.001 and p = 0.005).
Conclusions:
Despite the clinical importance of VUR timing, no studies have investigated the prognostic value of VUR timing for endoscopic therapy in primary VUR children. In this study, multivariate analysis revealed that the VUR grade and VUR timing on preoperative VCUG were significant predictors of success after endoscopic injection. Although the VUR grade is the most well-known factor that can affect the success of the procedure, VUR timing was a newly identified predictive factor. While patients with a filling reflux have lower success rates, patients with a voiding reflux were observed to show higher resolution rates after endoscopic injection. VUR timing on preoperative VCUG was found to be an independent predictive factor of VUR resolution after endoscopic therapy.
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