Diagnostic yield of CT urography in the evaluation of hematuria in young patients in a military population

Mace, Laura R.; Galloway, Terrel L; Ma, Andrew; Montgomery, Richard S.; Rockhill, Ryan C.; Reynolds, William W.; Marks, Robert M.

doi:10.1007/s00261-017-1084-9

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…Similar results were demonstrated in a retrospective review of 137 patients younger than 50 years with hematuria and a history of military service, which increased their risk of urinary tract malignancy due to higher tobacco use and occupational exposures not seen in the civilian population 9 ; 63% of clinically significant findings, most commonly urolithiasis, were diagnosed on unenhanced CT images. Contrast-enhanced images were recommended in 10% of patients to confirm benignity of abnormalities detected on the unenhanced images.…”

Section: Discussionsupporting

confidence: 74%

“…However, multiple studies demonstrating few clinically significant upper urinary tract findings in patients with hematuria, particularly in the younger population, suggest that indiscriminate exposure of patients to the high radiation doses of multiphasic CTU may not be indicated. [2][3][4][5][6][7][8][9] In patients with a bladder malignancy, the AUA recommends upper tract imaging for staging given the risk of a synchronous upper tract malignancy. 10 However, the benefit of upper tract imaging in patients evaluated for hematuria with negative cystoscopy remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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

2020

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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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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

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

2020

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“…Similarly, a study comparing CTU with unenhanced CT in the evaluation of asymptomatic microscopic hematuria in 442 adults <50 years old identified no upper urinary tract malignancies and calculated a theoretical maximum risk of 0.7% to 1.1%. 20 Mace et al 21 also found no malignancies in 137 patients <50 years of age with hematuria who were at increased risk of urological cancer. These studies affirm that the detection rate of upper urinary tract malignancies with CTU is exceedingly low in certain subgroups of patients.…”

Section: Discussionmentioning

confidence: 95%

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

2020

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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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Assessment of Diagnostic Yield of Cystoscopy and Computed Tomographic Urography for Urinary Tract Cancers in Patients Evaluated for Microhematuria

et al. 2021

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Diagnostic yield of CT urography in the evaluation of hematuria in young patients in a military population

Abstract: An unenhanced CT may be appropriate to evaluate new onset microscopic, and possibly gross hematuria, in patients younger than 40, even in patients at increased risk of urologic cancer.

Cited by 6 publications

References 17 publications

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

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

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

Assessment of Diagnostic Yield of Cystoscopy and Computed Tomographic Urography for Urinary Tract Cancers in Patients Evaluated for Microhematuria

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