Suson Kristina D, Preece Janae
Pediatric Urology The Children's Hospital of Michigan 3901 Beaubien Detroit, MI 48201, USA.
J Pediatr Urol. 2020 Oct;16(5):597.e1-597.e6. doi: 10.1016/j.jpurol.2020.04.003. Epub 2020 Apr 10.
In December 2014, Nguyen et al. introduced the Upper Tract Dilation (UTD) classification scheme, hoping to unify multiple disciplines when describing ultrasound imaging of congenital hydronephrosis. We hypothesized that the academic community has been slow to adopt its use in publications.
To evaluate which hydronephrosis grading systems were currently preferred in publications.
A PubMed® search for hydronephrosis was performed, and abstracts between May 2017 and May 2019 were reviewed. The following data points were collected from the 197 manuscripts meeting inclusion criteria: 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, manuscript type, and pathology were evaluated.
First and/or senior author specialties 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. 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%. The Summary Table presents grading system by manuscript type, specialty, and pathology.
There is great variability in hydronephrosis grading. One potential weakness of our study is that sufficient time may not have passed for the UTD system to be adopted. Researchers may need more time to complete and publish their studies, or could be awaiting further validation of UTD utility. They could also be hesitant to change systems when it is unknown if one classification schema is superior to another, either in general or for specific diagnoses. Another weakness is that this study does not quantify what, if any, systems are used clinically. Some attempt to provide objective classification would help clarify the implications of the manuscript for research or clinical applications. Reviewers should ensure that where possible, adequate descriptions of hydronephrosis are included. Education outreach to other specialties may help increase objective grading in research.
The UTD system is not commonly utilized in the literature. SFU grading is applied most commonly, followed by APD measurements. Over one third of manuscripts used no classification system or descriptive terminology.
2014年12月，阮等人引入了上尿路扩张（UTD）分类方案，希望在描述先天性肾积水的超声成像时统一多个学科。我们推测学术界在出版物中采用该方案的速度较慢。
评估目前出版物中更倾向使用哪种肾积水分级系统。
在PubMed®上搜索肾积水相关内容，并对2017年5月至2019年5月期间的摘要进行审查。从符合纳入标准的197篇手稿中收集以下数据点：期刊、第一作者和资深作者的专业、国家、文章类型、主要病理学以及存在肾积水时的肾积水分类。评估分类系统的使用与作者专业、手稿类型和病理学之间的差异。
第一作者和/或资深作者的专业最常见的是小儿泌尿外科、泌尿外科、小儿外科和小儿肾脏病学。这些手稿包括回顾性研究（48.2%）、前瞻性研究（25.4%）、病例报告（15.7%）、综述文章（9.1%）和系统评价（1.5%）。最常见的病理学是肾积水（36.5%）和肾盂输尿管连接部梗阻（21.3%）。超过20%的手稿根本没有对肾积水进行分类。UTD分类的使用比例为5.6%，而胎儿泌尿外科学会（SFU）分级的使用比例为37.1%，前后径（APD）测量的使用比例为32.5%。总结表按手稿类型、专业和病理学列出了分级系统。
肾积水分级存在很大差异。我们研究的一个潜在弱点是，UTD系统可能没有足够的时间被采用。研究人员可能需要更多时间来完成和发表他们的研究，或者可能在等待UTD效用的进一步验证。当不清楚一种分类方案在总体上或特定诊断中是否优于另一种方案时，他们也可能对改变系统犹豫不决。另一个弱点是，本研究没有量化临床上使用了哪些系统（如果有的话）。一些提供客观分类的尝试将有助于阐明手稿对研究或临床应用的意义。审稿人应确保在可能的情况下，包括对肾积水的充分描述。对其他专业的教育推广可能有助于提高研究中的客观分级。
UTD系统在文献中不常被使用。最常应用的是SFU分级，其次是APD测量。超过三分之一的手稿未使用分类系统或描述性术语。
