Journal of pediatric urology · 2026
Reduced-order, computational fluid dynamics-informed pressure-flow simulation of endoscopic injection therapy in pediatric vesicoureteral reflux: An in-silico evaluation of technique-dependent outcomes.
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Kim Jin Kyu, Roth Joshua, Whittam Benjamin, Batra Nikhil, Chua Michael, Misseri Rosalia
Аннотация
INTRODUCTION: Endoscopic bulking therapy is widely used to treat vesicoureteral reflux (VUR), yet technique selection remains largely empiric and outcomes vary by reflux grade and bladder dynamics. We developed a hypothesis-generating, reduced-order, computational fluid dynamics (CFD)-informed pressure-flow simulation intended to explore hydrodynamic mechanisms and injection-strategy tradeoffs.
METHODS: The model represents the bladder, ureterovesical junction, ureter, and renal pelvis as coupled pressure-flow elements. VUR grade templates modify competence, reverse resistance, dilation, tortuosity, compliance, and peristalsis; bladder-bowel dysfunction (BBD) is represented only as stylized pressure/outlet phenotypes. Injection modifies reverse and antegrade resistance through technique- and volume-dependent transformations. Reflux fraction (RF) was reflux volume divided by reflux plus antegrade volume; the obstruction index (OI) was a modeling safety ceiling, not a clinically validated threshold.
RESULTS: In the balanced 75-stratum simulation, the base-case OI ceiling selected Double HIT in 65 strata, Double HIT + STING in 9 strata, and HIT in 1 stratum. These are model outputs reflecting encoded multi-site geometry and volume-splitting assumptions. In the grade-V reference sweep, STING did not reach modeled RF resolution and exceeded the OI ceiling across tested volumes. Bilateral simulations showed small contralateral effects under the current shared-bladder coupling assumptions rather than strong clinical coupling. OI-threshold, mound-sigmoid, and tornado sensitivity analyses were added or specified to evaluate robustness of the model outputs.
CONCLUSIONS: This CFD-informed model offers a transparent, hypothesis-generating framework for comparing hydrodynamic consequences of endoscopic injection strategies. It does not establish clinical superiority, predict individual outcomes, or define validated treatment thresholds; external validation is required before clinical decision use.
METHODS: The model represents the bladder, ureterovesical junction, ureter, and renal pelvis as coupled pressure-flow elements. VUR grade templates modify competence, reverse resistance, dilation, tortuosity, compliance, and peristalsis; bladder-bowel dysfunction (BBD) is represented only as stylized pressure/outlet phenotypes. Injection modifies reverse and antegrade resistance through technique- and volume-dependent transformations. Reflux fraction (RF) was reflux volume divided by reflux plus antegrade volume; the obstruction index (OI) was a modeling safety ceiling, not a clinically validated threshold.
RESULTS: In the balanced 75-stratum simulation, the base-case OI ceiling selected Double HIT in 65 strata, Double HIT + STING in 9 strata, and HIT in 1 stratum. These are model outputs reflecting encoded multi-site geometry and volume-splitting assumptions. In the grade-V reference sweep, STING did not reach modeled RF resolution and exceeded the OI ceiling across tested volumes. Bilateral simulations showed small contralateral effects under the current shared-bladder coupling assumptions rather than strong clinical coupling. OI-threshold, mound-sigmoid, and tornado sensitivity analyses were added or specified to evaluate robustness of the model outputs.
CONCLUSIONS: This CFD-informed model offers a transparent, hypothesis-generating framework for comparing hydrodynamic consequences of endoscopic injection strategies. It does not establish clinical superiority, predict individual outcomes, or define validated treatment thresholds; external validation is required before clinical decision use.