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Approximately 40,000 to 50,000 children are diagnosed yearly with urinary tract dilation. 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 Society for Pediatric Radiology (SPR). A recent survey showed that pediatric radiologists have no standard method to describe urinary tract dilation. Some use a descriptive system (e.g., mild, moderate or severe) while others use standard grading systems (e.g., the Society of Fetal Urology’s numerical grading system 0–4). Ninety-five percent of SPR survey responders favor a standard system although the vast majority do not have a system to recommend [1]. Representatives from eight societies with interest in the diagnosis and management of fetuses and children with urinary tract dilation – the American College of Radiology (ACR), the American Institute of Ultrasound in Medicine (AIUM), the American Society of Pediatric Nephrology (ASPN), the Society for Fetal Urology (SFU), the Society for Maternal-Fetal Medicine (SMFM), the Society for Pediatric Urology (SPU), the SPR and the Society of Radiologists in Ultrasound (SRU) – agreed to collaborate on the development of a standard grading system for urinary tract dilation and make recommendations for follow-up evaluation. The consensus conference took place on March 14–15, 2014, in Linthicum, MD. The Consensus Panel proposed the UTD (Urinary Tract Dilation) Classification System to describe the appearance of the urinary tract both antenatally and postnatally. Recommendations for further evaluation of these patients were made based on the UTD grade. This new system is expected to be validated and/or modified with clinical experience and future research. The proposed UTD Classification System (Fig. 1) is based on six US findings: 1) anterior-posterior renal pelvic diameter (APRPD), 2) calyceal dilation with distinction between central and peripheral calyceal dilation postnatally, 3) renal parenchymal thickness, 4) renal parenchymal appearance, 5) bladder abnormalities and 6) ureteral abnormalities. For antenatal studies, the seventh US finding to report is the quantity of amniotic fluid. Normal values are also defined. The UTD Classification System distinguishes whether findings are antenatal (“A”) or postnatal (“P”). The higher the number, the more severe the findings. Thus, UTD A1 represents mild antenatal urinary tract dilation and UTD P3 represents severe urinary tract dilation and/or other abnormalities such as renal hyperechogenicity or a thick bladder wall after birth. Grading is based on the most severe finding. Because abnormalities of the urinary tract are more subtle and difficult to visualize in a fetus than in a child, there are only three antenatal categories (Normal, UTD A1, UTD A2-3) and four postnatal catagories (Normal, UTD P1, UTD P2 and UTD P3). Due to the great confusion associated with the implied meanings of various terminologies for urinary J. S. Chow (*) Departments of Radiology and Urology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02116, USA e-mail: Jeanne.chow@childrens.harvard.edu

Multidisciplinary consensus on the classification of antenatal and postnatal urinary tract dilation (UTD classification system)