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Cited by 561Pediatric Urology and Nephrology StudiesUrological Disorders and TreatmentsCongenital Anomalies and Fetal Surgery

Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system)

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Nguyen, Hiep T., Benson, Carol B., Bromley, Bryann, Campbell, Jeffrey B., Chow, Jeanne, Coleman, Beverly, Cooper, Christopher, Crino, Jude +5 more·2014·Journal of Pediatric Urology
DOI 10.1016/j.jpurol.2014.10.002
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Abstract

OBJECTIVE: Urinary tract (UT) dilation is sonographically identified in 1-2% of fetuses and reflects a spectrum of possible uropathies. There is significant variability in the clinical management of individuals with prenatal UT dilation that stems from a paucity of evidence-based information correlating the severity of prenatal UT dilation to postnatal urological pathologies. The lack of correlation between prenatal and postnatal US findings and final urologic diagnosis has been problematic, in large measure because of a lack of consensus and uniformity in defining and classifying UT dilation. Consequently, there is a need for a unified classification system with an accepted standard terminology for the diagnosis and management of prenatal and postnatal UT dilation. METHODS: A consensus meeting was convened on March 14-15, 2014, in Linthicum, Maryland, USA to propose: 1) a unified description of UT dilation that could be applied both prenatally and postnatally; and 2) a standardized scheme for the perinatal evaluation of these patients based on sonographic criteria (i.e. the classification system). The participating societies included American College of Radiology, the American Institute of Ultrasound in Medicine, the American Society of Pediatric Nephrology, the Society for Fetal Urology, the Society for Maternal-Fetal Medicine, the Society for Pediatric Urology, the Society for Pediatric Radiology and the Society of Radiologists in Ultrasounds. RESULTS: The recommendations proposed in this consensus statement are based on a detailed analysis of the current literature and expert opinion representing common clinical practice. The proposed UTD Classification System (and hence the severity of the UT dilation) is based on six categories in US findings: 1) anterior-posterior renal pelvic diameter (APRPD); 2) calyceal dilation; 3) renal parenchymal thickness; 4) renal parenchymal appearance; 5) bladder abnormalities; and 6) ureteral abnormalities. The classification system is stratified based on gestational age and whether the UT dilation is detected prenatally or postnatally. The panel also proposed a follow-up scheme based on the UTD classification. CONCLUSION: The proposed grading classification system will require extensive evaluation to assess its utility in predicting clinical outcomes. Currently, the grading system is correlated with the risk of postnatal uropathies. Future research will help to further refine the classification system to one that correlates with other clinical outcomes such as the need for surgical intervention or renal function.

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  1. Odibo AO, Raab E, Elovitz M, Merrill JD, Macones GA. Pre- natal mild pyelectasis: evaluating the thresholds of renal pelvic diameter associated with normal postnatal renal function. J Ultrasound Med 2004;23:513e7.
  2. Bromley B, Lieberman E, Shipp TD, Benacerraf BR. The ge- netic sonogram: a method of risk assessment for Down syn- drome in the second trimester. J Ultrasound Med 2002;21: 1087e96. quiz 97e8.
  3. Riccabona M, Fritz GA, Schollnast H, Schwarz T, Deutschmann MJ, Mache CJ. Hydronephrotic kidney: pedi- atric three-dimensional US for relative renal size asses- smenteinitial experience. Radiology 2005;236:276e83.
  4. Tibballs JM, De Bruyn R. Primary vesicoureteric refluxehow useful is postnatal ultrasound? Arch Dis Child 1996;75: 444e7.

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Authors
Nguyen, H. T., Benson, C. B., Bromley, B., Campbell, J. B., Chow, J., Coleman, B., Cooper, C., Crino, J., Darge, K., Anthony Herndon, C. D., Odibo, A. O., Somers, M. J. G., & Stein, D. R.
Affiliations
  • Society for Pediatric Urology (US)
  • American College of Radiology (US)
  • American Institute of Ultrasound in Medicine (US)
  • Society for Pediatric Radiology (US)
  • Society for Maternal-Fetal Medicine (US)
  • American Society of Pediatric Nephrology (US)
Corresponding author
Nguyen, Hiep T.
ORCID
Venue
Journal of Pediatric Urology
Publisher
Elsevier BV
Published
2014-12
Volume
10
Issue
6
Pages
982-998
ISSN
1477-5131 (ISSN-L)
DOI
10.1016/j.jpurol.2014.10.002
OpenAlex
W2027509324
Cited by
561
References
86
Citations by year
2026: 34 · 2025: 60 · 2024: 63 · 2023: 83 · 2022: 58 · 2021: 50 · 2020: 44 · 2019: 40 · 2018: 55 · 2017: 34 · 2016: 28 · 2015: 10
FWCI
22.55
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Pediatric Urology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
American Urological Association
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Urology and Nephrology Studies
  • Health Sciences › Medicine › Urology › Urological Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Congenital Anomalies and Fetal Surgery
Keywords
urinary tract dilatation, prenatal ultrasound, classification systems, renal pelvic diameter, renal parenchymal thickness, bladder abnormalities, gestational age, uropathies
MeSH terms
Dilatation, Pathologic, Female, Fetal Diseases, Humans, Infant, Newborn, Pregnancy, Urinary Tract, Urologic Diseases, Consensus

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