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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References
- Epidemiology and natural history of urinary tract infections in children.Med Clin. 1991; 75: 287-297
- Prevalence of urinary tract infection in febrile infants.J Pediatr. 1993; 123: 17-23
- Pediatric vesicoureteral reflux guidelines panel summary report: clinical practice guidelines for screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis.J Urol. 2010; 184: 1145-1151
- Acute pyelonephritis and sequelae of renal scar in pediatric first febrile urinary tract infection.Pediatr Nephrol. 2003; 18: 362-365
- Individualizing management of vesicoureteral reflux.Nephro-Urol Mon. 2012; 4: 530-534
- Computer model predicting breakthrough febrile urinary tract infection in children with primary vesicoureteral reflux.J Pediatr Urol. 2016; 12 (288.e1-.e5)
- Pediatric urinary tract infections: current controversies.Can J Urol. 2001; 8: 18-23
- Vesicoureteral reflux: the RIVUR study and the way forward.J Urol. 2008; 179: 405-407
- Inter-rater reliability of distal ureteral diameter ratio compared to grade of VUR.J Pediatr Urol. 2017; 13 (207.e1-.e5)
- Utility of the distal ureteral diameter on VCUG for grading VUR.J Pediatr Urol. 2015; 11 (183.e1-6)
- Validation of the ureteral diameter ratio for predicting early spontaneous resolution of primary vesicoureteral reflux.J Pediatr Urol. 2017; 13 (383.e1-.e6)
- Can distal ureteral diameter measurement predict primary vesicoureteral reflux clinical outcome and success of endoscopic injection?.J Pediatr Urol. 2019; 15 (515.e1-.e8)
- International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children.Pediatr Radiol. 1985; 15: 105-109
- The RIVUR trial: profile and baseline clinical associations of children with vesicoureteral reflux.Pediatrics. 2013; 132: e34-45
- Distal ureteral diameter measurement objectively predicts vesicoureteral reflux outcome.J Pediatr Urol. 2013; 9: 99-103
- Distal ureteral diameter ratio is predictive of breakthrough febrile urinary tract infection.J Urol. 2017; 198: 1418-1423
- Predicting breakthrough urinary tract infection: comparative analysis of vesicoureteral reflux index, grade and ureteral diameter ratio.J Urol. 2020; 204: 572-577
- Antimicrobial prophylaxis for children with vesicoureteral reflux.N Engl J Med. 2014; 370: 2367-2376
- Urinary tract infections in children: EAU/ESPU guidelines.Eur Urol. 2015; 67: 546-558
- Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months.Pediatrics. 2011; 128: 595-610
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.