Work

Analysis of risk factors for postoperative febrile urinary tract infection in children with primary vesicoureteral reflux

Year: 2026

Type: article

Abstract: Objective This study aims to identify risk factors for febrile urinary tract infection (fUTI) after surgery for primary vesicoureteral reflux (VUR) in children. Methods We conducted a retrospective cohort study of children diagnosed with VUR by voiding cystourethrography (VCUG) who underwent surgical intervention at our institution between January 2019 and December 2024. Patients were grouped based on the occurrence of postoperative fUTI. Univariate analyses were performed, and variables with P < 0.10 were entered into a modified Poisson regression model to identify independent risk factors, with particular focus on the vesicoureteral reflux index (VURx) and distal ureteral diameter ratio (UDR). A modified Poisson regression model with robust variance estimators was used to directly estimate relative risks (RR) due to the non-rare outcome. Results A total of 79 children (49 girls, 30 boys) were included, with a median surgical age of 28 months. Preoperatively, bladder bowel dysfunction (BBD) was present in 32 patients (40.5%) and renal scarring in 41 (51.9%). During the follow-up period from after stent removal to six months postoperatively, 13 children (16.5%) experienced at least one fUTI. Univariate analysis identified significant associations between postoperative fUTI and higher VUR grade ( P = 0.030), higher VURx score ( P = 0.001), larger ureteral diameter ( P < 0.001), higher UDR ( P < 0.001), presence of renal scarring ( P = 0.010), and presence of BBD ( P = 0.044). Modified Poisson regression analysis revealed that pre-existing renal scarring (RR=1.279, 95% CI 1.093–1.842, P = 0.024), a higher VURx score (RR=3.713, 95% CI 1.328–10.379, P = 0.012), and an increased UDR (RR=199.757, 95% CI 10.943–3646.268, P < 0.001) were independently associated with postoperative fUTI. The area under the curve (AUC) was 0.888 for UDR, 0.773 for VURx, and 0.937 for their combined model. Conclusion This exploratory analysis suggests that a UDR >0.446, VURx ≥5, and pre-existing renal scarring are associated with an increased risk of fUTI following VUR surgery. These hypothesis-generating findings highlight potential imaging markers for risk stratification but require validation in larger prospective studies.

Source: Journal of Pediatric Surgery Open

DOI: 10.1016/j.yjpso.2026.100282

Authors: Wenting Pei, Yin Zhang, Qihang Sun, Long You, Min Chao, Ye Zhang

Institution: Anhui Medical University

Language: English

Topic: Pediatric Urology and Nephrology Studies

Subfield: Pediatrics, Perinatology and Child Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,050