Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

This calculator interprets voiding cystourethrogram findings based on the International Reflux Study Committee grading system for vesicoureteral reflux. The interpretation is determined by examining the extent and severity of reflux as observed in the ureters, pelvis, and calyces, according to specific descriptions.

The input is gathered by selecting one of the predefined options for voiding cystourethrogram findings, each corresponding to a different level of reflux and structural changes:

1. Reflux into the ureter only
2. Reflux into the ureter, pelvis, and calyces; absence of dilatation; normal calyceal fornices
3. Mild or moderate dilatation and/or tortuosity of the ureter; mild or moderate dilatation of the renal pelvis; no or slight blunting of the fornices
4. Moderate dilatation and/or tortuosity of the ureter; moderate dilatation of the renal pelvis and calyces; complete obliteration of the sharp angle of the fornices; maintenance of the papillary impressions in the majority of calyces
5. Gross dilatation and tortuosity of the ureter; gross dilatation of the renal pelvis and calyces; the papillary impressions no longer visible in the majority of the calyces

The calculator processes these inputs to classify the reflux into one of the five grades:

| Voiding Cystourethrogram Findings                                     | Result  |
|-----------------------------------------------------------------------|---------|
| Reflux into the ureter only                                           | Grade I |
| Reflux into the ureter, pelvis, and calyces; absence of dilatation; normal calyceal fornices | Grade II |
| Mild or moderate dilatation and/or tortuosity of the ureter; mild or moderate dilatation of the renal pelvis; no or slight blunting of the fornices | Grade III |
| Moderate dilatation and/or tortuosity of the ureter; moderate dilatation of the renal pelvis and calyces; complete obliteration of the sharp angle of the fornices; maintenance of the papillary impressions in the majority of calyces | Grade IV |
| Gross dilatation and tortuosity of the ureter; gross dilatation of the renal pelvis and calyces; the papillary impressions no longer visible in the majority of the calyces | Grade V |

If none of the conditions match the predefined findings, the system returns a prompt to select an input for evaluation. Users are required to make a selection that aligns with their findings to receive a proper grading result.

The International Reflux Study Committee grading of vesicoureteral reflux is a clinical tool designed for the classification of vesicoureteral reflux severity in patients. This grading system is based on the findings from a voiding cystourethrogram, a diagnostic procedure that visualizes the urinary tract and can detect abnormalities such as reflux.

The primary components of this grading system are the extent and impact of the reflux, as visualized on the voiding cystourethrogram. The system consists of five grades, each corresponding to a specific set of findings. 

Grade I is assigned when reflux is observed into the ureter only. Grade II is assigned when reflux extends into the ureter, renal pelvis, and calyces, but there is no dilatation and the calyceal fornices remain normal. Grade III is assigned when there is mild or moderate dilatation and/or tortuosity of the ureter, mild or moderate dilatation of the renal pelvis, and no or slight blunting of the fornices. Grade IV is assigned when there is moderate dilatation and/or tortuosity of the ureter, moderate dilatation of the renal pelvis and calyces, complete obliteration of the sharp angle of the fornices, and maintenance of the papillary impressions in the majority of calyces. Finally, Grade V is assigned when there is gross dilatation and tortuosity of the ureter, gross dilatation of the renal pelvis and calyces, and the papillary impressions are no longer visible in the majority of the calyces.

The clinical utility of this grading system lies in its ability to stratify patients based on the severity of their vesicoureteral reflux. This can guide treatment decisions and provide a standardized method for assessing treatment efficacy.

Vesicoureteral reflux

Guidelines

Key sources