Hydronephrosis Classifications: Has UTD Overtaken APD and SFU? A Worldwide Survey

Area of Science:

• Pediatric Urology
• Medical Imaging Reporting
• Urologic Ultrasound

Background:

• Standardized reporting of pediatric hydronephrosis is crucial for consistent patient management.
• Current ultrasonographic reporting systems lack universal adoption and consensus among specialists.
• Variations in reporting can lead to misinterpretation and challenges in comparative studies.

Purpose of the Study:

• To assess current preferences and baseline information on ultrasonographic reporting systems for pediatric hydronephrosis.
• To identify factors influencing the choice of reporting systems among pediatric urologists globally.
• To evaluate the potential for a unified global system for hydronephrosis classification.

Main Methods:

• A 13-item multiple-choice questionnaire was distributed internationally to pediatric urologists, pediatric surgeons, and urologists.
• Statistical analysis included univariate, bivariate, and multivariate approaches to evaluate survey data.
• Data from 380 respondents across all continents were analyzed to determine reporting preferences and influencing factors.

Main Results:

• The Society for Fetal Urology (SFU) and Androgenetic Alopecia (APD) systems are most preferred due to familiarity and simplicity (37% and 34%).
• Imaging providers most frequently use the mild-moderate-severe system or APD measurements (28% and 39%), with a regional exception in North America favoring SFU (50%).
• Bivariate analysis revealed significant differences based on geographical area, experience, and case volume, though multivariate analysis showed no significant differences.

Conclusions:

• There is no single preferred pediatric hydronephrosis classification system among surveyed specialists.
• The primary limitation identified across all systems is the lack of universal utilization.
• While APD and SFU are currently favored, the newer Urinary Tract Dilation (UTD) system, combining elements of both, may evolve into a future universal standard.