Summary
Introduction
Many factors influence patient and provider decisions to surgically correct vesicoureteral
reflux (VUR), including risk of breakthrough febrile urinary tract infections and
likelihood of spontaneous resolution. Ureteral diameter ratio has been shown in several
studies to be more predictive than reflux grade with regard to breakthrough urinary
tract infection (UTI). We developed and investigated the accuracy of a computational
model for predicating febrile breakthrough urinary tract infection within 13 months
of starting prophylactic antibiotics in children with VUR.
Objective
The aim of this study was to validate a model for evaluating the impact of distal
ureteral diameter ratio (UDR) in predicting early breakthrough urinary tract infections
in children with VUR.
Study design
Following a retrospective review, we recorded patient demographics, presenting symptoms,
VUR grade, laterality, VUR during filling or voiding, initial bladder volume at the
onset of VUR, ureteral duplication, voiding dysfunction, distal ureteral diameter
ratio, and number of UTIs prior to VUR diagnosis. NeUROn++, a set of C++ programs,
was used to model each data set using logistic regression and neural networks with
different architectures.
Results
After exclusions, 136 children (93 girls and 43 boys) diagnosed with primary VUR had
detailed VCUG and UDR data available. Fourteen children (10.3%) experienced breakthrough
febrile UTI events within 13 months of VUR diagnosis. There was a significant association
with UDR and breakthrough UTI (p = 0.008). Various computational prediction models
for the outcome of breakthrough UTI were developed and evaluated. The computational
model that fit best was a model using all variables with an ROC of 0.802.
Discussion and conclusions
Clinicians and parents often opt for intervention based on likelihood of spontaneous
resolution of VUR as well as clinical course, thereby placing an emphasis on the ability
to predict likelihood of breakthrough UTI infections. Our statistical analysis and
prediction models further confirm UDR as an important variable predictive of breakthrough
UTIs within the first 13 months of beginning prophylactic antibiotics. Furthermore,
we developed a neural network model incorporating UDR and grade with an ability to
yield the greatest accuracy of any breakthrough UTI predictive calculator to date
at 80%.
Keywords
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Article info
Publication history
Published online: January 11, 2021
Accepted:
January 6,
2021
Received in revised form:
November 30,
2020
Received:
October 15,
2020
Identification
Copyright
© 2021 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
