CT Evaluation of Hematuria in Adults Younger than 50 Years in Military Service: Is Contrast-Enhanced Phase Needed?

Background: Limited data exist on the comparative diagnostic value of CT urography (CTU) versus unenhanced CT in evaluating the upper urinary tract in young adults (<50 years) with hematuria in active military service. This population may face an increased risk of urinary tract malignancies due to occupational exposures. Methods: We conducted a retrospective cohort study of 277 consecutive Israel Defense Forces personnel under 50 years old with new-onset hematuria referred for CT evaluation between 2011 and 2020. Two experienced radiologists first interpreted unenhanced CT images, followed by a review of contrast-enhanced phases. Findings were classified based on their detectability on unenhanced CT and whether contrast phases were required. Results: Of the 277 patients, 270 had microscopic hematuria and 7 had macroscopic hematuria. Imaging was normal in 158 cases. Among 119 patients (43%) with positive findings, 46 (16.6%) had clinically significant findings requiring follow-up or treatment. Of these, 42 (91%) were detectable on unenhanced CT alone. Contrast phases were requested in 15 cases (5.4%) and revealed additional benign findings. No urinary tract malignancies were identified. Conclusions: Unenhanced CT may be sufficient for evaluating new-onset hematuria in adults under 50, including active military personnel, minimizing the need for contrast administration.