Abstract
Background
As voiding cystourethrography is invasive and carries the risks of radiation and urinary tract infection, identifying only high-grade reflux is important. We aimed to identify risk factors for severe reflux in children presenting with urinary tract infections and/or urinary tract dilatation and to develop a prediction model for severe reflux.
Methods
Data of the children who underwent voiding cystourethrography due to urinary tract infections 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. Non-E. coli uropathogens, hydronephrosis, UTD-P3 dilatation, multiple renal scar, and decreased renal function on DMSA scintigraphy were associated with severe reflux. The prediction model by using these variables for severe reflux with a score ranging from 0–6 and an accuracy rate of 93.4% was developed. A score of ≥ 4 had a sensitivity 48.8%, specificity 95.8%, PPV 51.2%, and NPV 95.4% for severe reflux. Patients with ≥ 4 score were 21.9 times more likely to have severe reflux.
Conclusion
Non-E. coli uropathogen growth, the presence of hydronephrosis and especially UTD-P3 dilatation on ultrasonography, presence of multiple scars and decreased relative function on DMSA scintigraphy were found to be independent risk factors for severe reflux. Our scoring system based on these variables appears to be effective in predicting the presence of severe VUR.