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Background <p>As voiding cystourethrography is invasive and exposes to radiation and urinary tract infection (UTI), identifying only high-grade reflux is important. We aimed to identify clinical, laboratory and imaging variables associated with high-grade primary reflux in children presenting with UTIs and/or urinary tract dilatation and develop a prediction model for severe reflux.</p> Methods <p>Data of children who underwent voiding cystourethrography due to UTI and/or urinary tract dilatation were retrospectively analyzed for demographic, clinical and imaging findings. Patients with severe (grades 4–5) reflux were compared with the rest for these parameters and a prediction model was developed for severe reflux.</p> Results <p>The study included 1044 patients (574 female). Severe reflux was present in 86 (8.2%) patients. Age &lt; 2&#xa0;years, male sex, non-<i>E. coli</i> uropathogens, UTD-P3 dilatation and multiple kidney scars on DMSA scintigraphy were associated with severe reflux. Using these variables a prediction model for severe reflux with a score ranging from 0–7 and accuracy rate of 93.4% was developed. A score ≥ 5 had sensitivity 44.2%, specificity 97.4%, PPV 60.3%, NPV 95.1% and OR 29.5 for severe reflux. Scores ≥ 5 and ≥ 4 catch 44% and 73% of severe reflux, while prevent invasive voiding cystourethrography in 94.0% and 83.6% of patients, respectively.</p> Conclusion <p>Age &lt; 2&#xa0;years, male sex, non-<i>E. coli</i> uropathogen growth, presence of UTD-P3 dilatation on ultrasonography and multiple scars on DMSA scintigraphy are risk factors for severe reflux. A scoring system based on these variables appears to be effective in predicting the presence of severe reflux and eliminating unnecessary voiding cystourethrography.</p> Graphical abstract <p></p>

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Prediction model for severe vesicoureteral reflux in children with urinary tract infection and/or hydronephrosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月21日

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  • Pelin Laleoğlu,
  • Gizem Yildiz,
  • Meral Torun Bayram,
  • Handan Güleryüz Uçar,
  • Salih Kavukcu,
  • Alper Soylu

摘要

Background

As voiding cystourethrography is invasive and exposes to radiation and urinary tract infection (UTI), identifying only high-grade reflux is important. We aimed to identify clinical, laboratory and imaging variables associated with high-grade primary reflux in children presenting with UTIs and/or urinary tract dilatation and develop a prediction model for severe reflux.

Methods

Data of children who underwent voiding cystourethrography due to UTI and/or urinary tract dilatation were retrospectively analyzed for demographic, clinical and imaging findings. Patients with severe (grades 4–5) reflux were compared with the rest for these parameters and a prediction model was developed for severe reflux.

Results

The study included 1044 patients (574 female). Severe reflux was present in 86 (8.2%) patients. Age < 2 years, male sex, non-E. coli uropathogens, UTD-P3 dilatation and multiple kidney scars on DMSA scintigraphy were associated with severe reflux. Using these variables a prediction model for severe reflux with a score ranging from 0–7 and accuracy rate of 93.4% was developed. A score ≥ 5 had sensitivity 44.2%, specificity 97.4%, PPV 60.3%, NPV 95.1% and OR 29.5 for severe reflux. Scores ≥ 5 and ≥ 4 catch 44% and 73% of severe reflux, while prevent invasive voiding cystourethrography in 94.0% and 83.6% of patients, respectively.

Conclusion

Age < 2 years, male sex, non-E. coli uropathogen growth, presence of UTD-P3 dilatation on ultrasonography and multiple scars on DMSA scintigraphy are risk factors for severe reflux. A scoring system based on these variables appears to be effective in predicting the presence of severe reflux and eliminating unnecessary voiding cystourethrography.

Graphical abstract