A quantitative analysis of voiding cystourethrogram features confirms the association between highgrade vesicoureteral reflux with male sex, younger age, and hydronephrosis

Authors

  • Adree Khondker The Hospital for Sick Children, Toronto
  • Jethro C.C. Kwong University of Toronto
  • Priyank Yadav The Hospital for Sick Children, Toronto
  • Justin Y.H. Chan University of Toronto
  • Anuradha Singh The Hospital for Sick Children, Toronto
  • Lauren Erdman University of Toronto
  • Daniel T. Keefe IWK Hospital, Halifax
  • Mandy Rickard The Hospital for Sick Children, Toronto
  • Armando J. Lorenzo The Hospital for Sick Children, Toronto

DOI:

https://doi.org/10.5489/cuaj.8460

Keywords:

voiding cystourethrogram, vesicoureteral reflux, hydronephrosis, pediatric urology

Abstract

INTRODUCTION: Vesicoureteral reflux (VUR) is commonly diagnosed in the workup of urinary tract infections or hydronephrosis in children. Traditionally, VUR severity is graded subjectively based on voiding cystourethrogram (VCUG) imaging. Herein, we characterized the association between age, sex, and indication for VCUG, by employing standardized quantitative features.

METHODS: We included renal units with a high certainty in VUR grade (>80% consensus) from the qVUR model validation study at our institution between 2013 and 2019. We abstracted the following variables: age, sex, laterality, indication for VCUG, and qVUR parameters (tortuosity, ureter widths on VCUG). High-grade VUR was defined as grade 4 or 5 The association between each variable and VUR grade was assessed.

RESULTS: A total of 443 patients (523 renal units) were included, consisting of a 48:52 male/female ratio. The median age at VCUG was 13 months. Younger age at VCUG (<6 months) was associated with greater odds of severe VUR (odds ratio [OR] 2.0), and there was a weak correlation between age and VUR grade (⍴=-0.17). Male sex was associated with increased odds of high-grade VUR (OR 2.7). VCUGs indicated for hydronephrosis were associated with high-grade VUR (OR 4.1) compared to those indicated for UTI only. Ureter tortuosity and width were significantly associated with each clinical variable and VUR severity.

CONCLUSIONS: Male sex, younger age (<6 months), and history of hydronephrosis are associated with both high-grade VUR and standardized quantitative measures, including greater ureter tortuosity and increased ureteral width. This lends support to quantitative assessment to improve reliability in VUR grading.

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Published

2023-07-27

How to Cite

Khondker, A. ., Kwong, J. C. ., Yadav, P. ., Chan, J. Y. ., Singh, A. ., Erdman, L. ., Keefe, D. T. ., Rickard, M. ., & Lorenzo, A. J. . (2023). A quantitative analysis of voiding cystourethrogram features confirms the association between highgrade vesicoureteral reflux with male sex, younger age, and hydronephrosis. Canadian Urological Association Journal, 17(8), 243–6. https://doi.org/10.5489/cuaj.8460

Issue

Vol. 17 No. 8 (2023): CUAJ August

Section

Original Research

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