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Clinical Trajectory and Predictors of Conservative Management Failure in Primary Vesicoureteral Reflux With a History

Haotian Pan1, Xiangpan Kong1, Mengnan Jiang1

  • 1Department of Urology, Traditional Chinese Medicine Innovation Team, Laboratory for Targeted Delivery Application of Traditional Chinese Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; National Clinical Research Center for Children and Adolescents' Healthand Disorders, Chongqing, PR China; Children Urogenital Development and Tissue Engineering of Chongqing Education Commission of China, Chongqing, PR China; Children's Hospital of Chongqing Medical University, Chongqing, PR China.

Urology
|May 8, 2026
PubMed

Insights

Nearly 40% of children with vesicoureteral reflux (VUR) and urinary tract infections (UTIs) may require surgery. Platelet-to-lymphocyte ratio, ureteral diameter, and VUR grade predict failure of conservative management.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Clinical Risk Stratification

Background:

  • Primary vesicoureteral reflux (VUR) is a common cause of urinary tract infections (UTIs) in children.
  • Conservative management is often the initial approach, but failure rates and predictors are not fully elucidated.

Purpose of the Study:

  • To determine the natural course of conservative management for pediatric VUR with UTI history.
  • To identify risk factors for conservative management failure.
  • To develop a prognostic nomogram for personalized risk assessment.

Main Methods:

  • Retrospective analysis of 145 children with primary VUR and UTI history managed conservatively.
  • Evaluation of clinical data, maximum ureteral diameter (MUD), VUR grade, and immune-inflammatory markers.
  • Multivariate Cox regression and nomogram development with validation.

Main Results:

  • 38.6% of patients failed conservative management over a median follow-up of 26.5 months.
  • Cumulative surgical rates reached 22.1% at 1 year and 29.0% at 2 years.
  • Independent predictors of failure included high platelet-to-lymphocyte ratio (PLR), MUD > 7.5 mm, and high-grade VUR.

Conclusions:

  • A significant proportion of children with VUR and UTI history require surgery.
  • A nomogram integrating PLR, MUD, and VUR grade can aid in risk stratification.
  • This tool may support shared decision-making for timely surgical intervention.
Abstract

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