title: Evaluation of Urinary Tract Dilation Classification System for Grading Postnatal Hydronephrosis.
abstract: OBJECTIVE
  We assessed the reliability and validity of the Urinary Tract Dilation classification system as a new grading system for postnatal hydronephrosis.
  
  
  METHODS
  We retrospectively reviewed charts of patients who presented with hydronephrosis from 2008 to 2013. We included patients diagnosed prenatally and those with hydronephrosis discovered incidentally during the first year of life. We excluded cases involving urinary tract infection, neurogenic bladder and chromosomal anomalies, those associated with extraurinary congenital malformations and those with followup of less than 24 months without resolution. Hydronephrosis was graded postnatally using the Society for Fetal Urology system, and then the management protocol was chosen. All units were regraded using the Urinary Tract Dilation classification system and compared to the Society for Fetal Urology system to assess reliability. Univariate and multivariate analyses were performed to assess the validity of the Urinary Tract Dilation classification system in predicting hydronephrosis resolution and surgical intervention.
  
  
  RESULTS
  A total of 490 patients (730 renal units) were eligible to participate. The Urinary Tract Dilation classification system was reliable in the assessment of hydronephrosis (parallel forms 0.92). Hydronephrosis resolved in 357 units (49%), and 86 units (12%) were managed by surgical intervention. The remainder of renal units demonstrated stable or improved hydronephrosis. Multivariate analysis revealed that the likelihood of surgical intervention was predicted independently by Urinary Tract Dilation classification system risk group, while Society for Fetal Urology grades were predictive of likelihood of resolution.
  
  
  CONCLUSIONS
  The Urinary Tract Dilation classification system is reliable for evaluation of postnatal hydronephrosis and is valid in predicting surgical intervention.
authors.affiliation: Departments of Surgery and Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Department of Urology, Faculty of Medicine, Menoufia University, Al Minufya, Egypt. Electronic address: amrwuk@yahoo.co.uk.
authors.forename: Amr
authors.initials: A
authors.lastname: Hodhod
authors.affiliation: Departments of Surgery and Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: John-Paul
authors.initials: JP
authors.lastname: Capolicchio
authors.affiliation: Departments of Surgery and Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Roman
authors.initials: R
authors.lastname: Jednak
authors.affiliation: Department of Urology, Faculty of Medicine, Menoufia University, Al Minufya, Egypt.
authors.forename: Eid
authors.initials: E
authors.lastname: El-Sherif
authors.affiliation: Department of Urology, Faculty of Medicine, Menoufia University, Al Minufya, Egypt.
authors.forename: Abd El-Alim
authors.initials: Ael-A
authors.lastname: El-Doray
authors.affiliation: Departments of Surgery and Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Sherbiny
mesh_terms: D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000145:classification* / Q000473:pathology*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014551:Urinary Tract / Q000473:pathology*
keywords: diagnosis; hydronephrosis; multivariate analysis; patient outcome assessment