Utility of ureteral diameter ratio for clinical decision-making in children with vesicoureteral reflux: a systematic review and meta analysis

The aim of this study was to investigate the utility of ureteral diameter ratio (UDR) as a tool to prognosticate and manage vesicoureteral reflux (VUR). Four scientific databases (PubMed, EMBASE, Web of Science, and Scopus) were systematically searched. Inclusion criteria were all studies in which UDR was used in prognostication and/or management of VUR. An independent assessment of the methodological quality was performed by two authors using the Newcastle Ottawa Quality scale. The statistical analysis was performed using a random-effects model. Thirteen studies (all retrospective) were included in this review. Pooling the data demonstrated a significantly lower UDR in the spontaneous resolution vs. persistence of VUR group (p = 0.001). Also, the pooled data showed significantly higher values of UDR in the breakthrough UTI group (p < 0.00001), those requiring operative intervention (p = 0.03), and those with persistence of VUR after endoscopic treatment (p < 0.0001). The estimated heterogeneity for two outcomes, i.e., spontaneous resolution and requirement of operative intervention in VUR were substantial and statistically significant. All except one of the included studies were of good methodological quality. However, further studies are required to identify the cut-off values for these respective outcomes.