Association between ureteral jet angle by color Doppler ultrasonography and the clinical outcomes of vesicoureteral reflux.

Abstract

Vesicoureteral reflux is one of the common abnormalities in pediatric urology. We previously demonstrated that the ureteral jet angle is a useful noninvasive screening tool for detecting high-grade vesicoureteral reflux. To further explore its clinical application, we evaluated the association of ureteral jet angle with urinary tract infection development and vesicoureteral reflux improvement. We assessed the reliability of the ureteral jet angle measurement in 19 healthy adult volunteers in a prospective interrater reliability study. A retrospective study was conducted in 209 pediatric patients who presented with febrile urinary tract infection and underwent both voiding cystourethrography and ureteral jet angle measurement. The ureteral jet angle was unaffected by sex or laterality, showed a very weak positive correlation with bladder volume, and interrater reliability was high (intraclass correlation coefficient(2,1): 0.90). The ureteral jet angle was significantly higher in patients with multiple urinary tract infections (73.8° ± 2.1°) than in those with a single episode (67.8° ± 1.9°, p = 0.036). It was also higher in patients with breakthrough urinary tract infection (p = 0.013). In contrast, it was significantly lower in the group with vesicoureteral reflux downgrading (p < 0.001) and resolution (p < 0.001). Patients who underwent surgical intervention had a significantly higher ureteral jet angle than nonsurgical patients did (p < 0.001). Measuring the ureteral jet angle using color Doppler ultrasonography appears to be associated not only with vesicoureteral reflux grade but also with urinary tract infection development and vesicoureteral reflux improvement, supporting its role in vesicoureteral reflux management.