Is a Low Sacral Ratio Associated with Primary Vesicoureteral Reflux in Children?

The association of sacral anomalies with fecal incontinence and lower urinary tract dysfunction is known. The sacral ratio is proposed as a tool for evaluation of sacral development. The aim of this cross-sectional study was to evaluate the prevalence and severity of vesicoureteral reflux in children with a low sacral ratio. Six hundred and sixty nine children who were referred to a radiology clinic for a standard (fluoroscopic) VCUG to detect vesicoureteral reflux and other anomalies of the lower urinary tract after an episode of urinary tract infection were included in the study and their sacral ratios were measured. All children were younger than 14 years of age (mean 3.44±3.20). Of 669 children, 593 (88.6%) had normal sacral ratios out of whom 423 (71.3%) did not have VUR and 170 (28.7%) had VUR. Seventy-six (11.3%) children out of 669 cases had low sacral ratios; 49 (64.5%) of them had no VUR and 27 (35.5%) had VUR. There was no significant difference in the prevalence of VUR between children with and without a low sacral ratio (p value=0.217). Also, there was no significant difference or trend between a low sacral ratio and the severity of reflux (Chi2 for trend). Although sacral anomalies may be related to some cases of VUR by producing lower urinary tract dysfunction, the sacral ratio is not associated with VUR.