2022 Fiscal Year Final Research Report

Establishment of novel noninvasive diagnostic modality for vesicoureteral reflux using color Doppler ultrasonography

Research Project

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Project/Area Number	18K09207
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Review Section	Basic Section 56030:Urology-related
Research Institution	Keio University
Principal Investigator	ASANUMA Hiroshi 慶應義塾大学, 医学部(信濃町), 准教授 (70245570)
Co-Investigator(Kenkyū-buntansha)	大家基嗣慶應義塾大学, 医学部(信濃町), 教授 (00213885) 篠島利明慶應義塾大学, 医学部(信濃町), 講師 (60306777) 水野隆一慶應義塾大学, 医学部(信濃町), 准教授 (60383824)
Project Period (FY)	2018-04-01 – 2023-03-31
Keywords	膀胱尿管逆流 / 逆流性腎症 / 腎瘢痕 / カラードプラ法超音波検査 / 尿路感染症 / 先天性腎尿路異常 / 小児泌尿器疾患
Outline of Final Research Achievements	Color Doppler ultrasonography allows for clear visualization of the ureteral jet which is a bolus of urine from ureteral orifice to the bladder. We defined ureteral jet angle (UJA) as the angle between the direction of the ureteral jet and inter-ureteral ridge. The UJA value was not associated with sex, side of renal unit and bladder volume in 19 healthy adults. The inter-rater reliability was confirmed among 3 examiners (ICC=0.898), and time to UJA measurement by each examiner was 3.0-4.4 minutes. The UJA was significantly greater in renal units with renal scar (70.7±2.81 degrees) than in ones without renal scar (58.2±1.38 degrees, p<0.001). Univariate and multivariate analysis showed that UJA was significantly associated with renal scar (p<0.001). A cutoff angle 45 degrees or greater detected renal scar with a sensitivity of 98.0%. The UJA measurement could be a simple and noninvasive screening modality to detect renal scar as well as vesicoureteral reflux with good reliability.
Free Research Field	泌尿器科学（小児泌尿器科学）
Academic Significance and Societal Importance of the Research Achievements	本研究は、発生学および解剖学的知見に基づいて尿管口jet角に着目した点、非侵襲的かつ簡便な超音波検査を用いて膀胱尿管逆流および逆流性腎症の診断法を確立し得る点において、合理的であるとともに独創的な発想によるものである。したがって、その学術的意義は極めて大きいと考える。また、新生児期から思春期以降の成人期に至るどの年齢層の患者に対しても排尿を待たずに仰臥位で短時間に評価できる普遍的な検査法であることから、臨床的にも大きな貢献となり得る。さらに、造影検査やアイソトープ検査が不要となる患者が増えることによって医療経済の効率化においても社会的意義は極めて大きいと考える。