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MULTIDISCIPLINARY

CONSENSUS ON THE
CLASSIFICATION OF ANTENATAL
AND POSTNATAL URINARY
TRACT DILATION
UTD CLASSIFICATION

Dr Vassil Zefov
08.12. 2015 LH
UTD CLASSIFICATION

Correlation between antenatal and postnatal US findings has been


difficult due to the lack of consensus in defining and describing urinary
tract dilation

There is variability not only among subspecialty groups, but also within
the Societies of Pediatric Radiology.

A recent survey showed that pediatric radiologists have no standard


method to describe urinary tract dilation

Some are descriptive system (e.g. , mild, moderate, or severe) while


others use standard grading system (e.g., Grade 1-4 )
UTD CLASSIFICATION

Representatives from eight societies with interest in the diagnosis


and management of fetuses and children with UTD agreed to
collaborate on the development of standard grading system for
UTD - urinary tract dilation

1) ACR - American College of Radiology


2) AIUM - American Institute of Ultrasound in Medicine
3) ASPN - American Society of Pediatric Nephrology
4) SFU - Society for Fetal Urology
5) SMFM - Society for Maternal-Fetal Medicine
6) SPU - Society of Pediatric Urology
7) SPR - Society of Pediatric Radiology
8) SRU - Society of Radiologists in Ultrasound
UTD CLASSIFICATION

The Consensus Panel proposed the UTD Classification System to describe the
appearance of the urinary tract in both - antenatally and postnatally.

The proposed UTD Classification System is based on six ultrasound findings:

1) A-P diameter of renal pelvis


2) Calyceal dilation with distinction between central and peripheral calyceal
dilation (postnatally)
3) Renal parenchyma thickness.
4) Renal parenchymal appearance
5) Bladder abnormalities
6) Ureteral abnormalities
UTD CLASSIFICATION

1) The UTD Classification System distinguishes whether the findings are


antenatal ( A ) or postnatal ( P )

P
UTD CLASSIFICATION

1) The UTD Classification System distinguishes whether the findings are


antenatal ( A ) or postnatal ( P )

A normal

A A1
A2-3

P normal
P1
P2

P P3
UTD CLASSIFICATION

1) The UTD Classification System distinguishes whether the findings are


antenatal ( A ) or postnatal ( P )

16-27 weeks
< 4mm A-P

A normal

>28 weeks
< 7 mm A-P
UTD CLASSIFICATION

1) The UTD Classification System distinguishes whether the findings are


antenatal ( A ) or postnatal ( P )

16-27 weeks
4 mm 7 mm A-P

A 1

>28 weeks
7 mm 10 mm A-P
UTD CLASSIFICATION

Transversal Sagital

A 2-3
Peripheral 16-27 weeks
Calyceal > 7 mm A-P
dilatation,

Ureteral
dilatation,

Renal
parenchyma >28 weeks
Bladder >10 mm A-P
abnormalities
UTD CLASSIFICATION

1) The UTD Classification System distinguishes whether the findings are


antenatal ( A ) or postnatal ( P )

P normal A-P
< 10 mm
UTD CLASSIFICATION
Transversal Sagital

A-P
10 15 mm

P 1
Central
calyceal
dilation
UTD CLASSIFICATION
Transversal Sagital

A-P
> 15 mm

P 2
Peripheral
calyceal
dilation
UTD CLASSIFICATION
Transversal Sagital

Additional
Regardless A-P

Ureteral
dilation

P 3 Renal
echogenic
parenchyma

Renal cysts

Bladder
abnormalities
UTD CLASSIFICATION

The Consensus Panel recommends consistent use of term


dilation and avoiding the use of non-specific terms such
as :

Hydronephrosis

Pyelectasis

Pelviectasis

Renal pelvis fullness


UTD CLASSIFICATION

When reporting urinary tract dilation, a description of the proposed six


imaging parameters should be described in the body of the report.

In the Conclusion should be included the specific UTD categories

A P
Normal Normal
UTD A1 UTD P1
UTD A 2-3 UTD P2
UTD P3
UTD CLASSIFICATION

Scenario Defensive management

Antenatal Report - Bilateral renal fullness ( A-P 4 mm )

Postnatal Report Bilateral fullness ( A-P 7 mm ) To be followed up

After 3 m Request For MCU with diagnosis :


Bilateral hydronephrosis
To R/O VUR
UTD CLASSIFICATION

Tips to avoid Defensive behaviour :

For Radiologist - Wright Normal when it is normal instead


measurements .

A normal Avoid - Fullness with A-P 5 mm


P normal Avoid A-P 5 mm . To be followed up

For Clinicians - Avoid US exam of NB in the first 48 hrs. It will be


misinterpret.
Avoid request for MCU if it is normal and no signs of UTI
UTD CLASSIFICATION

THANK YOU