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2021 update on the urinary dilation (UTD) classification system: clarifications, review of the literature, and practical suggestions
2021 update on the urinary dilation (UTD) classification system: clarifications, review of the literature, and practical suggestions
REVIEWED BY | Leanne Lamborn ASA SIG: Paediatric
REFERENCE | Authors: Hiep T Nguyen, Andrew Phelps, Brian Coley, Kassa Darge, Audrey Rhee, Jeanne S Chow Journal: Pediatric Radiology (2022) 52:740–751 Open Access: No
WHY THE STUDY WAS PERFORMED
The aim of the paper was to look at the assessment of renal tract dilation. There is often a huge variability in recommendations for further imaging and follow-up of both fetus and children with urinary tract dilation. Trying to determine the management of these patients can be difficult. This is due to a wide range of clinical practices with how the US findings are reported. Historically there has not been uniformity in the definition or classification of the urinary tract system in both the pre and postnatal periods. This lack of correlation between the prenatal and postnatal US findings and the final urologic diagnosis has been problematic due to this lack of consensus.
WHAT THE PAPER LOOKED AT
The assessment of renal tract dilation has been challenging due to the different languages used between prenatal and postnatal care. A major benefit of UTD is the classification of a normal kidney, especially in infants. The main classification system that was being used previously was the SFU grading system in fetuses. The UTD classification system is a unified method of describing the urinary tract dilation in fetuses and infants using terminology that is common. The UTD classification system was initially introduced to promote research outcomes. Multiple studies have been done by different organisations looking at the UTD classification system reliability. By determining the best method of assessment, it allows improvement of outcomes of patients by ensuring the correct management pathway is determined.
WHAT THE STUDY FOUND
It found that by implementing the UTD classification system into reporting of both antenatal and postnatal care gives a more uniform management to patients. Research has indicated that after several years of initiating the UTD classification grading system, a better clinical outcome has been given. This is because there is better inter-rater reliability when compared to other classification systems. The UTD classification system intra-rater reliability remained the same for both the UTD and the SFU.
RELEVANCE TO CLINICAL PRACTICE
The main purpose of having a common language for renal dilation was to promote outcomes research, which was done. The research proved that by using the UTD classification it provides a uniform system to describe the antenatal and postnatal urinary tract dilation. There is also no cutoff age for using the UTD classification system; therefore, the goal being eventually to see it more widely adopted into different subspecialties to create a standardised management option that will ultimately optimise patient care.
