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BLADDER DIAMETER RATIO: A RED FLAG FOR
THE RISK OF UPPER TRACT DAMAGE IN PATIENTS
WITH NEUROPATHIC BLADDER DYSFUNCTION
Ahmed ABDELHALIM
1
, Miriam FAHIM
2
, Elias WEHBI
1
and Antoine KHOURY
1
1) University of California, Irvine and the Children’s Hospital of Orange County, Department of Urology, Orange, USA -
2) Eastern Virgina Medical School, Norfolk, USA
PURPOSE
Up to 30-50% of patients with neuropathic bladder may have some degree of renal damage. We
sought to identify if the bladder diameter ratio (BDR: the ratio of the midpoint of the bladder height to
the midpoint of the bladder width on the antero-posterior view on a VCUG at maximum cystometric
capacity) can be used to identify patients at-risk of upper tract damage in neuropathic bladder
patients.
MATERIAL AND METHODS
The electronic records of pediatric patients diagnosed with neuropathic bladder in a single institution
were retrospectively reviewed. Patients with history of bladder or ureteral surgery, less than two
years of follow-up or incomplete follow-up data were excluded. Baseline and follow up VCUGs were
reviewed for BDR. Evolution of hydronephrosis on serial ultrasounds was tested against BDR at
baseline and last follow-up.
RESULTS
Between 2008 and 2016, 52 males and 38 females with 179 renal units (RU) met the study cri-
teria. Hydronephrosis was demonstrated in 52 (29.3%) RU at baseline. A total of 30 (16.8%) RU
showed persistent/worsening hydronephrosis after a median follow-up of 87.5 (24-140) months.
RU with persistent/worsening hydronephrosis had significantly higher BDR relative to those with
no or resolving hydronephrosis both at baseline (1.5+0.25 vs. 1.37+0.239, p=0.008) and follow-up
(1.498+0.25 vs. 1.353+0.25, p=0.004).
CONCLUSIONS
BDR is a useful indicator of bladder hostility in neuropathic bladder patients. Patients with elevated
BDR are more likely to exhibit upper tract deterioration and would benefit from more vigilant surveil-
lance and aggressive proactive treatment.