Clinical outcome is associated with the Urinary Tract Dilatation Classification System grade.

AIM: To assess the association between the Urinary Tract Dilatation (UTD) Antenatal (A) and Postnatal (P) Classification System grade and the outcome in term newborns. METHODS: This retrospective study enrolled 166 term newborns (71% boys, 206 ureterorenal units) evaluated for unilateral or bilateral UTD in the Neonatology Department of Ljubljana University Medical Center from 2012 to 2018. Data on family history, sex, gestational age, birth weight, head circumference, Apgar score, possible oligohydramnios, indication for and age at first postnatal ultrasound, time of follow-up, and clinical outcome were collected. Radiology records were reviewed to grade UTD according to the Multidisciplinary Consensus on the Classification of Prenatal and Postnatal UTD. RESULTS: The majority of ureterorenal units with UTD A 2-3 had UTD P 2 or 3. Spontaneous resolution, specific uropathy, the need for surgery, and the risk of urinary tract infection were all significantly associated with the UTD P grade. No patient experienced renal dysfunction at the end of follow-up (12-48 months, median 24 months), and therefore this parameter was not associated with the UTD P grade. CONCLUSIONS: The UTD grade was associated with the probability of spontaneous resolution, time to its occurrence, specific uropathies urinary tract infection, and risk for surgery. However, no association with renal dysfunction was established.

Six of one, half a dozen of the other: A measure of multidisciplinary inter/intra-rater reliability of the society for fetal urology and urinary tract dilation grading systems for hydronephrosis.

INTRODUCTION: The urinary tract dilation (UTD) classification system was introduced to standardize terminology in the reporting of hydronephrosis (HN), and bridge a gap between pre- and postnatal classification such as the Society for Fetal Urology (SFU) grading system. Herein we compare the intra/inter-rater reliability of both grading systems. MATERIALS AND METHODS: SFU (I-IV) and UTD (I-III) grades were independently assigned by 13 raters (9 pediatric urology staff, 2 nephrologists, 2 radiologists), twice, 3 weeks apart, to 50 sagittal postnatal ultrasonographic views of hydronephrotic kidneys. Data regarding ureteral measurements and bladder abnormalities were included to allow proper UTD categorization. Ten images were repeated to assess intra-rater reliability. Krippendorff's alpha coefficient was used to measure overall and by grade intra/inter-rater reliability. Reliability between specialties and training levels were also analyzed. RESULTS: Overall inter-rater reliability was slightly higher for SFU (α = 0.842, 95% CI 0.812-0.879, in session 1; and α = 0.808, 95% CI 0.775-0.839, in session 2) than for UTD (α = 0.774, 95% CI 0.715-0.827, in session 1; and α = 0.679, 95% CI 0.605-0.750, in session 2). Reliability for intermediate grades (SFU II/III and UTD 2) of HN was poor regardless of the system. Reliabilities for SFU and UTD classifications among Urology, Nephrology, and Radiology, as well as between training levels were not significantly different. DISCUSSION: Despite the introduction of HN grading systems to standardize the interpretation and reporting of renal ultrasound in infants with HN, none have been proven superior in allowing clinicians to distinguish between "moderate" grades. While this study demonstrated high reliability in distinguishing between "mild" (SFU I/II and UTD 1) and "severe" (SFU IV and UTD 3) grades of HN, the overall reliability between specialties was poor. This is in keeping with a previous report of modest inter-rater reliability of the SFU system. This drawback is likely explained by the subjective interpretation required to assign grades, which can be impacted by experience, image quality, and scanning technique. As shown in the figure, which demonstrates SFU II (a) and SFU III (b), as assigned by a radiologist, it is possible to make an argument that either of these images can be classified into both categories that were observed during the grading sessions of this study. CONCLUSION: Although both systems have acceptable reliability, the SFU grading system showed higher overall intra/inter-rater reliability regardless of rater specialty than the UTD classification. Inter-rater reliability for SFU grades II/III and UTD 2 was low, highlighting the limitations of both classifications in regards to properly segregating moderate HN grades.

[Remarks on the introduction of the German Diagnosis-Related Groups (DRGs) for the specialty of urology]. / Anmerkungen zur Einführung der Deutschen Diagnosis-related Groups (G-DRGs) für das Fach Urologie.

In January 2003 a new system to charge inpatient treatment was established in Germany: the G-DRGs. This system is based on the thought that equal medical service causes equal costs all over Germany. Hospitals offering a broad spectrum of diagnostics and therapies and being unable to select their patients according to economical aspects are put at disadvantage: Despite a perfect documentation the G-DRGs reflect their medical service only in an insufficient way. Tools for an optimized coding must be a coding manual created for the specific needs of urologists and an infrastructure that allows a permanent quality control for all persons involved.