Analysis of indications for ureteral reimplantation in 3738 children with vesicoureteral reflux: A single institutional cohort

Konrad M. Szymanski, Lorena M. Oliveira, Andres Silva, Alan B. Retik, Hiep T. Nguyen

Research output: Contribution to journalArticle

13 Scopus citations


Purpose: No method exists for predicting which child with vesicoureteral reflux (VUR) will have surgery. Our goals were to analyze practice patterns at a major pediatric center and to identify factors predisposing children to surgery for specific indications. Materials and methods: We analyzed a cohort of 3738 children presenting with primary VUR (1996-2005). Surgical indications included: 1) breakthrough urinary tract infection (UTI), 2) non-resolution over 3 years, 3) renal scan abnormality and 4) parent/surgeon preference. Logistic regression was applied to a random 60% subset of children. Validation in the remaining 40% was done using receiver operating characteristic curve analysis and the Hosmer and Lemeshow goodness-of-fit test. Results: Independent predictors of surgery included higher age at presentation, antenatal hydronephrosis (ANH), bilateral VUR and VUR grade. Predictors of surgery for a breakthrough UTI included female gender, increasing age, and bilateral and high-grade VUR. Girls were less likely than boys to be operated for renal scan abnormality or parent/surgeon preference. ANH was a predictor of surgery for decreased function and parent/surgeon preference. The model had fair discrimination (c-statistic = 0.68-0.76) and high calibration (p ≥ 0.24). Probabilities of surgery were calculated. Conclusions: Higher age at presentation, being followed for ANH, and bilateral and high-grade VUR are independent predictors of VUR-corrective surgery. Predictors of surgery vary with indication. Our methods allow comparison of urological practice patterns and outcomes between institutions by taking into account indications for surgery.

Original languageEnglish (US)
Pages (from-to)601-610
Number of pages10
JournalJournal of Pediatric Urology
Issue number6
StatePublished - Dec 1 2011
Externally publishedYes


  • Child
  • Physician's practice patterns
  • Statistical model
  • Urologic surgical procedures
  • Vesicoureteral reflux

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

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