Dynamic Hydrodistention of the Ureteral Orifice: A Novel Grading System With High Interobserver Concordance and Correlation With Vesicoureteral Reflux Grade

Abstract

The dynamic hydrodistention classification is a reliable method of evaluating the presence or absence of vesicoureteral reflux as it correlates significantly with radiographic reflux grade. It has high interobserver concordance.

Diagnostic value of hydrodistention of the ureteral orifice

“…The grading is as follows: H0 denotes absence of ureteral dilation; H1 indicates dilation of the ureteral orifice only; H2 allows visualization of the intramural ureter; H3 allows visualization of the extramural ureter. The H0 and H1 grades were considered as normal, H2 and H3 grades were considered as abnormal [7].…”

“…The HD classification is a basic and objective way of rating the ureteral orifice opening. Also, this method has high interobserver concordance [7]. Kirsch et al [7] reported that ureters with hydrodistention grades H0eH1 should be considered normal and at low risk for VUR, while H2eH3 ureters should be considered abnormal because they are more likely to reflux.…”

“…Also, this method has high interobserver concordance [7]. Kirsch et al [7] reported that ureters with hydrodistention grades H0eH1 should be considered normal and at low risk for VUR, while H2eH3 ureters should be considered abnormal because they are more likely to reflux. Likewise, some authors have shown that all ureters that reflux on the PIC cystography are also hydrodistensible [5,6,8].…”

Does compliance status predict clinical status in patients undergoing endoscopic management of vesico-ureteral reflux?

“…A second injection is made at the distal aspect of the tunnel at the location of the ureteral orifice and serves to coapt the ureteral meatus. After each injection, hydrodistention of the ureter is carried out, and if the ureter still hydrodistends a third injection is performed using the classic STING (subureteric Teflon injection) method [7,8]. The mean volume of injection was determined for each ureter treated.…”

“…The mean volume of injection was determined for each ureter treated. Higher volumes were needed for higher degrees of ureteral hydrodistention [8].…”