# Ultrasound-based predictive indicators for treatment outcomes in pediatric vesicoureteral reflux

## TL;DR

This study shows that ultrasound measurements of specific urinary tract features can predict treatment success for a common childhood kidney condition.

## Contribution

Identified detrusor-to-ureteral orifice distance and its ratio to ureteral diameter as novel ultrasound-based predictors of VUR treatment outcomes.

## Key findings

- Renal scarring was significantly more common in treatment failure cases (90.9%) than in success cases (38.1%).
- Shorter detrusor-to-ureteral orifice distance and lower D/U ratio were strongly associated with treatment failure.
- A detrusor-to-ureteral orifice distance below 7.4 mm predicted an 81.82% likelihood of treatment failure.

## Abstract

To evaluate the effectiveness of preoperative ultrasound (US) measurements in predicting pediatric vesicoureteral reflux (VUR) treatment outcomes.

This prospective study enrolled 35 patients (53 renal units) aged 1–16 years who underwent subureteric injection therapy for primary VUR between July 2020 and June 2022. Preoperative ultrasound examinations measured the bladder wall thickness at the ureteral orifice, ureteral submucosal tunnel length, distal ureteral diameter, patient demographics, VUR grade, presenting complaints, bladder–bowel dysfunction, and renal scarring, and the impact of these variables on treatment success was analyzed.

Among the patients, 91.4% were female, with a mean age of 6.83 ± 3.84 years. A comparison between the treatment success and failure groups revealed no significant differences in the age, sex, VUR grade, laterality, bilaterality, presenting complaints, bladder–bowel dysfunction, bladder wall thickness, or distal ureteral diameter (p > 0.05). However, renal scarring occurred in 16 (38.1%) patients in the treatment success group and 10 (90.9%) in the treatment failure group (p = 0.002). The treatment failure group had shorter detrusor-to-ureteral orifice distances and smaller detrusor-ureteral orifice distance-to-distal ureteral diameter (D/U) ratios than that of the success group (p = 0.004 and p = 0.006, respectively). Patients with a detrusor-to-ureteral orifice distance < 7.4 mm had an 81.82% likelihood of treatment failure.

Ultrasound measurements of the detrusor-to-ureteral orifice distance and D/U ratio proved reliable in predicting the success of endoscopic subureteric injection therapy for VUR.