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Do Current Scientific Reports of Hydronephrosis Make the Grade?
Kristina D. Suson, MD, Janae Preece, MD.
Children's Hospital of Michigan, Detroit, MI, USA.

BACKGROUND: In December 2014, Nguyen et al. introduced the Upper Tract Dilation (UTD) classification scheme, with a hope of unifying multiple disciplines when describing ultrasound imaging of congenital hydronephrosis. Attempts to define clinical outcomes related to the system have been ongoing since. We hypothesized that the academic community has been slow to adopt its use in publications.
METHODS: A Pubmed search for hydronephrosis was performed, and abstracts between May 2017 and May 2019 were reviewed. The full manuscript of abstracts meeting the following criteria were analyzed: abstract available, human subjects, English, and pediatric. Manuscripts not primarily about hydronephrosis, including non-congenital hydronephrosis, with adult patients, or not including ultrasound data, were excluded. The following data points were collected from the remaining 197 manuscripts: journal, first and senior author specialty, country, type of article, primary pathology, and classification of hydronephrosis when present. Differences between use of classification system, and author specialty and type of manuscript were compared using Chi-square analysis.
RESULTS: Manuscripts from 88 journals with authors from 41 countries or multiple countries were included. More than 20 specialties were represented. The first and/or senior author were most commonly pediatric urology, urology, pediatric surgery, and pediatric nephrology. The manuscripts were comprised of retrospective studies (48.2%), prospective studies (25.4%), case reports (15.7%), review articles (9.1%), and systematic reviews (1.5%). The most common pathologies were hydronephrosis (36.5%) and ureteropelvic junction obstruction (21.3%). Over 20% of manuscripts did not categorize hydronephrosis at all, while 53.8% used one method and 25.9% used two methods of classification. The UTD classification was used by 5.6%, while Society for Fetal Urology (SFU) grading was used by 37.1% and Anterior-Posterior Diameter (APD) measurements by 32.5%. Approximately one third either used no system or only descriptions such as mild, moderate, or severe. The type of article using no or descriptive classifications varied: systematic reviews (0%), prospective (20%), reviews (27.8%), retrospective (34.7%), and case reports (58.1%), p=0.006. Manuscripts written by the four most commonly represented first and/or senior authors specialties were less likely to use no or descriptive classifications than those written by other specialties (29.2% versus 46.3%, p=0.032). Manuscripts about hydronephrosis and ureteropelvic junction obstruction were more likely characterize the degree of hydronephrosis than other diagnoses (78.9% versus 49.4%, p<0.001).
CONCLUSIONS: There is great variability in hydronephrosis grading. Despite incorporating the opinions of multiple disciplines into its creation, the UTD system is not commonly utilized in the literature. SFU grading is used most commonly, followed by APD measurements. While at this time, it is unknown if one classification schema is superior to another, either in general or for specific diagnoses, some attempt to provide objective classification would help clarify the implications of the manuscript. Reviewers should ensure that where possible, objective classifications are included. Education outreach to other specialties may help increase objective grading in research.


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