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Computed tomography-urography for upper urinary tract imaging: is it required for all patients who present with

Evelyne C C Cauberg1, C Y Nio, Jean M C H de la Rosette

  • 1Department of Urology, Academic Medical Center, Amsterdam, the Netherlands. e.c.cauberg@amc.uva.nl

Journal of Endourology
|August 20, 2011
PubMed

Insights

For microscopic hematuria, ultrasonography suffices to rule out upper urinary tract disease. Macroscopic hematuria warrants CT urography (CTU) due to a higher likelihood of detecting significant upper urinary tract (UUT) pathology.

Area of Science:

  • Urology
  • Radiology
  • Diagnostic Imaging

Background:

  • Hematuria, a common urological symptom, requires accurate diagnostic imaging to identify the source.
  • Determining the appropriate imaging modality for upper urinary tract (UUT) evaluation is crucial for efficient patient management.

Purpose of the Study:

  • To define patient criteria for utilizing computed tomography (CT) urography for upper urinary tract (UUT) imaging in cases of hematuria.
  • To establish the diagnostic yield of CT urography (CTU) in patients presenting with microscopic or macroscopic hematuria.

Main Methods:

  • Prospective study of 841 patients in a hematuria clinic (2006-2010).
  • Standard hematuria workup followed by risk-factor-based selection for additional UUT imaging (ultrasonography or CT urography/MR urography).
  • Analysis of predictive factors for cross-sectional urography findings.

Main Results:

  • Cross-sectional urography identified relevant UUT lesions in 13.9% of patients.
  • Ultrasonography results and hematuria type were significant predictors for CTU/MRU findings.
  • CT urography/MR urography detected missed lesions in 9.6% of cases initially negative on ultrasonography, primarily stones.

Conclusions:

  • Ultrasonography is adequate for excluding significant UUT disease in microscopic hematuria.
  • CT urography is recommended as a first-line test for macroscopic hematuria due to increased detection rates of UUT disease.
Abstract

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