Clinical and Radiological Risk Factors Predicting Open Surgical Repair in Pediatric Patients With Dilating Vesicoureteral Reflux.
OBJECTIVE
To study the individual patient-related risk factors in those undergoing open corrective vesicoureteral reflux (VUR) surgery in a contemporary series. The management of VUR remains controversial, and the indications for open surgery has evolved from that of surgeon and patient preference to criteria involving breakthrough urinary tract infections and grade of VUR.


METHODS
A retrospective study was performed, and patients undergoing open surgical repair for dilating VUR (grade III-V) from 2005 to 2014 were included. Characteristics of patients were determined to identify predictors of operative intervention. Statistical analysis including Fisher's exact test and multivariable logistic regression of patient demographics and independent predictors of surgery was performed using the Stata (College Station, TX) version 13 software package.


RESULTS
Of the 469 patients, 351 (74.8%) underwent open intravesical ureteroneocystostomy and 118 (25.2%) were managed conservatively. Based on the multivariable analysis, age, female sex, number of febrile urinary tract infections, maximum grade of reflux, prenatal hydronephrosis, ureteral dilatation, and persistence of VUR on voiding phase of voiding cystourethrogram were strong predictors of eventual surgery. Female sex (odds ratio [OR]: 19.8), ureteral dilatation (OR: 6.2), and persistence of VUR on voiding phase (OR: 5.03) were among the strongest predictors of surgical intervention.


CONCLUSIONS
Female sex and higher grades of VUR were the strongest predictors of eventual surgical intervention. VCUG characteristics of ureteral dilatation >7 mm and persistence of VUR on the voiding phase were also very strong predictors of eventual surgical intervention.
Division of Pediatric Urology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: pankajdangle@gmail.com.
Pankaj P
PP
Dangle
Division of Pediatric Urology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA.
Omar
O
Ayyash
Division of Pediatric Urology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA.
Jathin
J
Bandari
School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
Audry
A
Kang
Division of Pediatric Urology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA.
Heidi A
HA
Stephany
Division of Pediatric Urology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA.
Glenn M
GM
Cannon
Division of Pediatric Urology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA.
Francis X
FX
Schneck
Division of Pediatric Urology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA.
Michael C
MC
Ost
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D014513:Ureter / Q000000981:diagnostic imaging / Q000601:surgery*; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000601:surgery*; D014567:Urography / Q000379:methods*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis* / Q000601:surgery; D055815:Young Adult