Diagnosing urinary tract abnormalities: intravenous urography or CT urography?

Over the last two decades, the exponential use of CT in the assessment of the urological patient has been fuelled by the advent of multidetector thin slice CT and supersession of intravenous urography by CT urography. The latter may be considered as a one-stop imaging investigation for haematuria, with increased detection of urinary tract cancers and urolithiasis alike. Multi-planar reformats are made possible with the use of thin slices, allowing clear delineation of other pathologies such as urinary tract injury, and can aid PCNL planning. Outside of this spectrum, unenhanced CT of the kidneys, ureters, and bladder has established its role in assessment of the patient with symptoms of renal colic, with the scope to detect pathology outside of the urinary tract. Renal CT has been developed for the characterization of renal masses, accompanied by the now well-established Bosniak renal cyst classification system.

Download Full-text

Computed tomography

10.1093/med/9780199592548.003.0014 ◽

2015 ◽

Author(s):

Eugene Teoh ◽

Michael J. Weston

Keyword(s):

Computed Tomography ◽

Urinary Tract ◽

Intravenous Urography ◽

Ct Urography ◽

Renal Masses ◽

Safety Issues ◽

Unenhanced Ct ◽

Iodinated Contrast Medium ◽

Iodinated Contrast ◽

Multiplanar Reformats

Computed tomography (CT) has increased in use exponentially for the assessment of patients with renal tract pathology. This has been promoted by the availability of multidetector thin-slice CT so that intravenous urography has been superseded by CT urography. The latter may be considered as a ‘one-stop’ imaging investigation for haematuria, with increased detection of both urinary tract cancers and urolithiasis. Multiplanar reformats are made possible with the use of thin slices, allowing clear delineation of other pathologies such as urinary tract injury. In the transplant recipient, protocols have been developed for the assessment of more immediate complications such as thrombotic and stenotic disease. During follow-up, CT continues to inform the management of post-transplant lymphoproliferative disorder and other immunosuppressant-related complications. Unenhanced CT of the urinary tract has established its role in assessment of patients with renal colic, with the ability to detect pathology outside of the urinary tract. Renal CT has been developed for the characterization of renal masses, accompanied by the now well-established Bosniak renal cyst classification system. As the usefulness of CT increases, clear awareness of safety issues has to be maintained. These include the administration of intravenous iodinated contrast medium in higher-risk patient groups, particularly those with renal impairment. The radiation burden that comes with CT poses an added risk to the patient that should not be ignored. This necessitates clear referral guidelines for its use, which should be applied in careful balance with the global assessment of the patient.

Download Full-text

Ureteral Dilatation with No Apparent Cause on Intravenous Urography: Normal or Abnormal? A Pilot Study

Advances in Urology ◽

10.1155/2015/681836 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Vinita Rathi ◽

Sachin Agrawal ◽

Shuchi Bhatt ◽

Naveen Sharma

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Pilot Study ◽

Tract Infection ◽

Intravenous Urography ◽

Vascular Compression ◽

Ct Urography ◽

Laboratory Investigations ◽

Ureteral Dilatation ◽

Clinically Significant

A pilot study was done in 18 adults to assess the significance of ureteral dilatation having no apparent cause seen on Intravenous Urography (IVU). A clinicoradiological evaluation was undertaken to evaluate the cause of ureteral dilatation, including laboratory investigations and sonography of the genitourinary tract. This was followed, if required, by CT Urography (using a modified technique). In 9 out of 18 cases, the cause of ureteral dilatation on laboratory investigations was urinary tract infection (6) and tuberculosis (3). In the remaining 9 cases, CTU identified the cause as extrinsic compression by a vessel (3), extrinsic vascular compression of the ureter along with ureteritis (2), extrinsic vascular impression on the right ureter and ureteritis in the left ureter (1), ureteral stricture (2), and ureteral calculus (1). Extrinsic vascular compression and strictures did not appear to be clinically significant in our study. Hence, ureteral dilatation without any apparent cause on intravenous urogram was found to be clinically significant in 12 out of 18 (66.6%) cases. We conclude that ureteral dilatation with no apparent cause on IVU may indicate urinary tract tuberculosis, urinary tract infection (E. coli), or a missed calculus. Thus, cases with a dilated ureter on IVU, having no obvious cause, should undergo a detailed clinicoradiological evaluation and CTU should be used judiciously.

Download Full-text