Prevalence of Urologic Disease Among Patients Investigated for Hematuria With CT Urography

Purpose: The current study evaluated the prevalence of urologic disease among patients with hematuria referred for computerized tomography (CT) urography to determine which patients require investigation with CT urography. Methods: We retrospectively reviewed radiology reports of 1046 CT urograms performed for the indication of microscopic (43.7%) or gross hematuria (56.3%). Urological findings were categorized as negative, benign, or suspicious (pathologically confirmed) for malignancy. Results: Of 1046 CT urograms performed, 53.5% were negative, 36.4% were benign, and 10% were suspicious for malignancy. The most common benign finding was urolithiasis (22.3%). Overall, urinary tract malignancies were present in 3.6% of patients, and the rate was significantly higher ( P < .001) for gross (5.8%) than microscopic hematuria (0.9%). CT urography identified 0.6% patients with upper urinary tract malignancies; the malignancy rate was significantly higher ( P = .038) for gross (1%) than microscopic hematuria (0%), and no significant sex ( P = 1.00; male = 0.6%, female = 0.6%) or age ( P = .600; < 50 years = 0%, ≥ 50 years = 0.7%) differences were observed. Logistic regression revealed that being male was associated with gross hematuria (odds ratio [OR] = 2.92), and that both age and gross hematuria (ORs = 1.06 and 5.13, respectively) were associated with malignancy. Conclusions: CT urography found no upper urinary tract malignancies in 99.4% of patients presenting with hematuria, including all patients with microscopic hematuria and those with gross hematuria <50 years old. Investigating these subgroups with CT urography may be unnecessary and result in increased patient morbidity and health-care costs.

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Diagnostic utility of axial imaging in the evaluation of hematuria: A systematic review and critical appraisal of the literature

Canadian Urological Association Journal ◽

10.5489/cuaj.6522 ◽

2020 ◽

Vol 15 (2) ◽

Author(s):

Christopher J.D. Wallis ◽

Rashid K. Sayyid ◽

Roni Manyevitch ◽

Nathan Perlis ◽

Vinata B. Lokeshwar ◽

...

Keyword(s):

Systematic Review ◽

Urinary Tract ◽

Meta Analysis ◽

Sampling Bias ◽

Upper Urinary Tract ◽

Risk Of Bias ◽

Microscopic Hematuria ◽

Gross Hematuria ◽

Upper Tract ◽

Tract Cancer

Introduction: Increasing severity of hematuria is instinctively associated with higher likelihood of urological malignancy. However, the robustness of the evidentiary base for this assertion is unclear, particularly as it relates to the likelihood of upper urinary tract pathology. Thus, the value of axial imaging in the diagnostic workup of hematuria is unclear due to differences in the underlying patient populations, raising concern for sampling bias. We performed a systematic review to characterize the literature and association between severity of hematuria and likelihood of upper urinary tract cancer based on axial imaging. Methods: MEDLINE, EMBASE, and Cochrane were systematically searched for all studies reporting on adult patients presenting with hematuria. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for reporting of this systematic review and meta-analysis and the Newcastle-Ottawa Scale for risk of bias assessment. Degree of hematuria was classified as “microscopic,” “gross,” or “unspecified.” Three urologic malignancies (bladder, upper tract urothelial, and renal cancer) were considered both individually and in aggregate. Random effects model with pairwise comparisons was employed to arrive at the axial imaging diagnostic yields. Results: Twenty-nine studies were included, of which six (20.7%) reported on patients with gross hematuria only, four (13.8%) reported on patients with microscopic hematuria only, seven (24.1%) included both, and 12 (41.4%) did not define or specify the severity of hematuria. Of 29 studies, two (6.9%) were at high-risk of bias, 21 (72.4%) at intermediate-risk, and six (20.7%) at low-risk of bias using the Newcastle-Ottawa criteria. Based on axial imaging, rates of diagnoses of renal, upper tract urothelial, and bladder cancers differed with differing severity of hematuria. Notably, rates of renal and upper tract urothelial carcinoma were higher in studies of patients with unspecified hematuria severity (3.6% and 10.4%, respectively) than among patients with gross hematuria (1.5% and 1.3%, respectively). When all urological malignancies were pooled, patients with unspecified hematuria were diagnosed more frequently (19.5%) compared to those with gross (15.3%) and microscopic hematuria (4.5%, difference = 1.51%; 99% confidence interval 3.6–26.5%). Conclusions: Lack of granularity in the available literature, particularly with regards to patients with unspecified hematuria severity, limits the generalizability of these results and highlights the need for future studies that provide sufficient baseline information allowing for firmer conclusions to be drawn.

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Current Concepts in Imaging Asymptomatic Hematuria

Medical Research Archives ◽

10.18103/mra.v9i4.2382 ◽

2021 ◽

Vol 9 (4) ◽

Author(s):

Jason Kim ◽

Christopher Lisanti ◽

Ryan Schwope ◽

Helal Syed ◽

Forrest Jellison

Keyword(s):

Urinary Tract ◽

Current Knowledge ◽

Imaging Techniques ◽

Upper Urinary Tract ◽

Microscopic Hematuria ◽

North American Society ◽

Gross Hematuria ◽

Imaging Evaluation ◽

Urinary Tract Stones ◽

American Society

Hematuria is a very common clinical condition that most clinicians will encounter. Hematuria is divided into gross and microscopic hematuria with a wide variety of etiologies. The imaging evaluation of asymptomatic hematuria is generally tailored to identifying a common cause (urinary tract stones) and the most worrisome cause (carcinoma). The workup for asymptomatic gross hematuria is generally agreed upon and includes both CT and cystoscopy. However, the imaging evaluation of asymptomatic microscopic hematuria is controversial due to the much lower risk of urinary tract malignancies. The purpose of this article is to review the imaging of the upper urinary tract focusing on CT, MRI, and ultrasound. Current European and North American society guidelines, imaging techniques, typical imaging findings, diagnostic accuracy, and risks will all be addressed highlighting the current knowledge gaps, particularly between CT and ultrasound.

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CT Urography Findings of Upper Urinary Tract Carcinoma and Its Mimickers: A Pictorial Review

Medicina ◽

10.3390/medicina56120705 ◽

2020 ◽

Vol 56 (12) ◽

pp. 705

Author(s):

Paola Martingano ◽

Marco F. M. Cavallaro ◽

Alessandro M. Bozzato ◽

Elisa Baratella ◽

Maria A. Cova

Keyword(s):

Urinary Tract ◽

Disease Management ◽

Urothelial Carcinoma ◽

Imaging Modality ◽

Upper Urinary Tract ◽

Ct Urography ◽

Pictorial Review ◽

Computed Tomography Urography ◽

Very High ◽

Upper Urinary Tract Carcinoma

Urothelial carcinoma (UC) is the fourth most frequent tumor in Western countries and upper tract urothelial carcinoma (UTUC), affecting pyelocaliceal cavities and ureter, accounts for 5–10% of all UCs. Computed tomography urography (CTU) is now considered the imaging modality of choice for diagnosis and staging of UTUC, guiding disease management. Although its specificity is very high, both benign and malignant diseases could mimic UTUCs and therefore have to be well-known to avoid misdiagnosis. We describe CTU findings of upper urinary tract carcinoma, features that influence disease management, and possible differential diagnosis.

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687 BIMODAL PATTERN OF THE IMPACT OF BODY MASS INDEX ON CANCER-SPECIFIC SURVIVAL OF UPPER URINARY TRACT UROTHELIAL CARCINOMA PATIENTS: MULTI-CENTER STUDY IN A 1114-CASE TOKYO METROPOLITAN DATABASE OF UROLOGIC DISEASE (TMDU) COHORT

The Journal of Urology ◽

10.1016/j.juro.2013.02.243 ◽

2013 ◽

Vol 189 (4S) ◽

Author(s):

Junichiro Ishioka ◽

Hitoshi Masuda ◽

Yoh Matsuoka ◽

Noboru Numao ◽

Fumitaka Koga ◽

...

Keyword(s):

Body Mass Index ◽

Urinary Tract ◽

Urothelial Carcinoma ◽

Upper Urinary Tract ◽

Cancer Specific Survival ◽

Urologic Disease ◽

Multi Center Study ◽

The Impact ◽

Center Study ◽

Urinary Tract Urothelial Carcinoma

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Examining the upper urinary tract in patients with hematuria—time to revise the CT urography protocol?

European Radiology ◽

10.1007/s00330-019-06521-0 ◽

2019 ◽

Vol 30 (3) ◽

pp. 1664-1670 ◽

Cited By ~ 2

Author(s):

Erik Rud ◽

Kristina Flor Galtung ◽

Peter Mæhre Lauritzen ◽

Eduard Baco ◽

Tove Flatabø ◽

...

Keyword(s):

Urinary Tract ◽

Upper Urinary Tract ◽

Ct Urography

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The Diagnostic Yield of CT Urography in the Workup of Hematuria With Negative Cystoscopy

Canadian Association of Radiologists Journal ◽

10.1177/0846537120933952 ◽

2020 ◽

pp. 084653712093395

Author(s):

Jessica Common ◽

Milita Ramonas ◽

Abdullah Alabousi

Keyword(s):

Computed Tomography ◽

Urinary Tract ◽

Diagnostic Yield ◽

Imaging Modality ◽

Patient Characteristics ◽

Upper Urinary Tract ◽

Added Value ◽

Smoking History ◽

Ct Urography ◽

Computed Tomography Urography

Purpose: To determine the diagnostic yield of computed tomography urography (CTU) in patients evaluated for hematuria with negative cystoscopy and to assess the added value of CTU when compared with ultrasound (US) in this patient population. Methods: A retrospective study was conducted of patients who underwent CTU within 12 months of negative cystoscopy for workup of hematuria at our institution from January 2016 to December 2017. Computed tomography urography findings were recorded and compared to clinical diagnoses to determine diagnostic yield. Computed tomography urography and US findings were compared in patients who underwent both examinations. Patient characteristics (age, sex, smoking history, and hematuria subtype) were reported. Results: A total of 657 patients met the inclusion criteria, including 108 patients aged 50 years and younger. No cause for hematuria was identified in 41% of patients overall and 58% of patients aged 50 years and younger. The most common diagnoses were benign prostatic hyperplasia and urolithiasis, accounting for 25% and 21% of patients, respectively; 0.6% of patients were diagnosed with an upper urinary tract malignancy, all older than 50 years. Although US was superior or equal to CTU for diagnosis in 83% of patients who underwent both examinations, US had a 0% sensitivity for detection of upper urinary tract malignancy. Conclusion: The low diagnostic yield of CTU and low prevalence of upper urinary tract malignancy in patients evaluated for hematuria with negative cystoscopy, particularly those aged 50 years and younger, call into question the appropriateness of multiphasic CTU as a first-line imaging modality in this population.

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The clinical importance of microscopic hematuria and hydronephrosis in urolithiasis

10.22541/au.162439742.24363477/v1 ◽

2021 ◽

Author(s):

Kamil Kokulu ◽

ekrem taha sert

Keyword(s):

Risk Factors ◽

Odds Ratio ◽

Clinical Importance ◽

Microscopic Hematuria ◽

Ureteral Stones ◽

Stone Size ◽

Factors Associated ◽

Radiology Reports ◽

Contrast Ct ◽

The Relationship

Aim: The aim of this study was to investigate the relationship between the degree of hydronephrosis and the presence of microscopic hematuria in patients that presented to the emergency department (ED) with ureteral stones. Methods: The records of patients who presented to our ED due to urolithiasis between January 2017 and December 2020 were retrospectively analyzed. Patients aged 18 years or older who underwent non-contrast computed tomography (CT abdomen/pelvis) and urinalysis (UA) and were diagnosed with ureteral stones were included in the study. Radiology reports were reviewed for stone size, localization, and degree of hydronephrosis. Patients with and without microscopic hematuria and the degree of hydronephrosis were compared. Results: A total of 476 patients were included, which consisted of 391 with microscopic hematuria and 85 without microscopic hematuria. The median stone size was 4.1 mm in the presence of microscopic hematuria and 5.5 mm in the absence of microscopic hematuria. Logistic regression analysis was performed to determine the factors associated with the development of hydronephrosis. Stone size [odds ratio (OR):2.15, 95% confidence interval (CI):1.12-4.16, p<0.001), presence of pyuria (OR: 2.58, 95%CI: 1.78-3.48, p<0.001), and absence of microscopic hematuria (OR: 1.31, 95%CI 1.04-2.89, p=0.017) were identified as risk factors for moderate and severe hydronephrosis. Conclusion: We consider that non-contrast CT imaging is necessary for the diagnosis and treatment of emergency cases in which microscopic hematuria is not detected in urinalysis since their stone size may be larger and degree of hydronephrosis may be more severe.

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