Diagnostic accuracy of ureteric jet angle and location in children with vesicoureteric reflux: A retrospective study

Abstract

Background: Vesicoureteral reflux (VUR) is a common urological abnormality in children that can lead to urinary tract infections and renal scarring. Micturating cystourethrogram (MCU) is the gold standard for diagnosis but is invasive and involves radiation exposure. This study investigates the diagnostic accuracy of ureteric jet angle (UJA) and midline to ureteric orifice distance (MOD) measurements using colour Doppler ultrasonography as a non-invasive alternative. Objectives: To determine the association between UJA and MOD with the presence and severity of VUR in children referred for MCU. Methods: This retrospective diagnostic accuracy study in an Australian quaternary paediatric hospital included 42 children (68 renal units) referred for MCU to investigate suspected VUR. Colour Doppler ultrasonography was used identify the ureteric jets, permitting measurement of UJA and MOD, which were compared to MCU results (reference standard). Analysis included ROC curves, Mann–Whitney and Kruskal–Wallis tests. Results: VUR was present in 25 of 68 units (36.8%). Thirty-two males and 10 females included; mean age 10 months 18 days (range: 26 days to 8 years). Median UJA for VUR units 67.0° (IQR 46.0°) versus non-VUR 51.0° (IQR 26.0°), p = 0.002. Median MOD for VUR units 8.9 mm (IQR 7.2 mm) versus non-VUR 5.8 mm (IQR 4.2 mm), p = 0.006. Diagnostic Accuracy: UJA: AUC 0.728 (95% CI: 0.590–0.866), optimal cut-off 56.5°. MOD: AUC 0.701 (95% CI: 0.568–0.835), optimal cut-off 6.7 mm. Discussion: UJA and MOD measurements show potential as non-invasive indicators of VUR presence. However, they did not reliably differentiate between individual grades of VUR severity. Registration: Not applicable.