Association Between Ureteral Jet Angle by Color Doppler Ultrasonography and the Clinical Outcomes of Vesicoureteral Reflux.

PURPOSE: Vesicoureteral reflux (VUR) is one of the common abnormalities in pediatric urology. We previously demonstrated that the ureteral jet angle (UJA) is a useful noninvasive screening tool for detecting high-grade VUR. To further explore its clinical application, we evaluated the association of UJA with UTI development and VUR improvement.

MATERIALS AND

METHODS

We assessed the reliability of the UJA 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 UTI and underwent both voiding cystourethrography and UJA measurement.

RESULTS

The UJA 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 UJA was significantly higher in patients with multiple UTIs (73.8° ± 2.1°) than in those with a single episode (67.8° ± 1.9°, P = .036). It was also higher in patients with breakthrough UTI (P = .013). By contrast, it was significantly lower in the group with VUR downgrading (P < .001) and resolution (P < .001). Patients who underwent surgical intervention had a significantly higher UJA than nonsurgical patients did (P < .001).

CONCLUSIONS

Measuring the UJA using color Doppler ultrasonography appears to be associated not only with VUR grade but also with UTI development and VUR improvement, supporting its role in VUR management.