{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T17:55:38Z","timestamp":1789840538143,"version":"4.0.1"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,10,5]],"date-time":"2020-10-05T00:00:00Z","timestamp":1601856000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Paquin asserts that in order for ureterovesical junctions (UVJs) to prevent reflux, the ureteral tunnel length\u2010to\u2010diameter ratio needs to be 5:1. We hypothesize that the surgical implementation of this observation results in an overestimation of the needed length\u2010to\u2010diameter ratio to prevent vesicoureteral reflux.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>With finite elements, we model the urine storage phase of the bladder under nonlinear conditions. In the reference state, the bladder is assumed to be a sphere with an oblique straight elliptical hole as the UVJ. Broad parametric studies on different length\u2010to\u2010diameter ratios are performed as the bladder volume increases from 10% to 110% capacity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The capability of the UVJ to prevent reflux during storage depends on its length\u2010to\u2010diameter ratio. UVJs with larger length\u2010to\u2010diameter ratios lengthen and narrow as the bladder volume increases, causing the closure of the UVJ and rise in its flow resistance. Our model shows that the UVJ length\u2010to\u2010diameter ratio decreases as the bladder volume increases. The 5:1 ratio implemented at 80% capacity\u2014approximate volume or bladder wall stretch during ureteroneocystostomy (UNC)\u2014corresponds to 7:1 at the reference state\u2014used by Paquin. The 5:1 ratio implemented at the reference state corresponds to 3:1 at 80% capacity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our modeling results are consistent with Paquin's original observation on the significance of the UVJ length\u2010to\u2010diameter ratio in preventing reflux. They, however, indicate that the surgical implementation of this rule during UNC results in an overestimation of the requisite tunnel length\u2010to\u2010diameter ratio to prevent reflux. They also suggest that the UVJ closure is due to the bladder wall deformation rather than the pressure.<\/jats:p><\/jats:sec>","DOI":"10.1002\/nau.24526","type":"journal-article","created":{"date-parts":[[2020,10,5]],"date-time":"2020-10-05T15:37:38Z","timestamp":1601912258000},"page":"85-94","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The 5:1 rule overestimates the needed tunnel length during ureteral reimplantation"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5254-6705","authenticated-orcid":false,"given":"Kourosh","family":"Kalayeh","sequence":"first","affiliation":[{"name":"Department of Urology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4536-3919","authenticated-orcid":false,"given":"J.","family":"Brian Fowlkes","sequence":"additional","affiliation":[{"name":"Department of Radiology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7499-7868","authenticated-orcid":false,"given":"William W.","family":"Schultz","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9576-0077","authenticated-orcid":false,"given":"Bryan S.","family":"Sack","sequence":"additional","affiliation":[{"name":"Department of Urology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,5]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)65934-2"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)62184-0"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)65186-3"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)65215-7"},{"issue":"2","key":"e_1_2_8_6_1","first-page":"189","article-title":"Coming full circle with vesicoureteral reflux: from hutch to bladder and bowel dysfunction","volume":"13","author":"Penna F","year":"2017","journal-title":"J Pediatr Urol"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-011-1933-7"},{"key":"e_1_2_8_8_1","doi-asserted-by":"crossref","unstructured":"KalayehK FowlkesJB ShultzWW SackBS.\u00a0Ureterovesical junction deformation during bladder storage and the effect on vesicoureteral reflux. 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