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Gezer M, Karaca L, Özdemir Z, Kahraman A, Oğuz F, Erbay MF, Yetiş H. Use of dual energy CT urography in evaluation of urinary stone and complex cyst. Turk J Med Sci 2023; 53:264-272. [PMID: 36945947 PMCID: PMC10388052 DOI: 10.55730/1300-0144.5581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/22/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Dual-energy computed tomography scans can provide significant benefits to the urinary system. The aim of this study is to determine the limitations and benefits of using dual energy CT urography in patients with urinary system stones and cysts. METHODS In the analysis of the images, the virtual noncontrasted images obtained from the combined nephrogenicexcretory phase and the true noncontrasted images were evaluated. The true noncontrast images were accepted as the gold standard for stone detection. RESULTS Eighty-three different stones were detected in 26 of the 115 patients included in the study. Sensibilities of virtual noncontrast images in detecting urinary system stones were 66.7% and 65.4% according to the first and second radiologists, respectively. In this study, 32 hyperdense cysts were detected. According to iodine map images, there was no enhancement in 26 of 32 cysts; only 5 cysts showed minimal contrast enhancement. One patient could not decide on contrast enhancement. DISCUSSION As a result, if CT urography is performed with dual energy, it can provide additional information in patients with urinary system disorder.
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Affiliation(s)
- Mehmet Gezer
- Department of Radiology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Leyla Karaca
- Department of Radiology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Zeynep Özdemir
- Department of Radiology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Ayşegül Kahraman
- Department of Radiology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Fatih Oğuz
- Department of Urology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Mehmet Fatih Erbay
- Department of Radiology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Hüseyin Yetiş
- Department of Radiology, Faculty of Medicine, İnönü University, Malatya, Turkey
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Patel VA, Popat NP. Essentials of Computed Tomography Imaging of Hematuria. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:61-79. [PMID: 38092717 DOI: 10.4103/1319-2442.391003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Hematuria is defined usually as the presence of blood in the urine, either on voiding or in a catheterized specimen. Hematuria is broadly divided into microscopic and gross hematuria and may be symptomatic or asymptomatic. The causes of hematuria include a very wide spectrum of conditions. However, here, we have filtered the causes causing gross hematuria, including calculus, trauma, tumors, vascular, and miscellaneous causes. Plain X-rays of the kidney, ureter, and bladder; ultrasound; intravenous urography; computed tomography (CT); magnetic resonance imaging; retrograde ureterography and pyelography (RGP); cystoscopy; and ureteroscopy are techniques that are useful for diagnosis. In the past, one or a combination of several techniques was used to evaluate hematuria but recently, advances in CT urography mean that it can be used alone for this task. This article briefly reviews the common causes of gross hematuria in adults and their evaluation by CT-based urography. Gross hematuria is evaluated well with CT scan urography which includes an unenhanced scan, the nephrographic phase, and the excretory phase. Unenhanced scans are routinely performed to evaluate the basic parameters such as the size, shape, position, and outline of the kidneys and calculus disease, which is the most common cause of hematuria. Renal parenchymal diseases including masses are best visualized in the nephrographic phase along with other abdominal organs. Delayed excretory phases including the kidneys, ureters, and bladder are useful for detecting urothelial diseases. CT urography's protocol permits evaluations of hematuria through a single examination.
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Affiliation(s)
- Vaidehi A Patel
- Department of Radio Diagnosis and Imaging, G. R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
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Jung C, Brubaker L. The etiology and management of recurrent urinary tract infections in postmenopausal women. Climacteric 2019; 22:242-249. [PMID: 30624087 PMCID: PMC6629580 DOI: 10.1080/13697137.2018.1551871] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/17/2018] [Indexed: 01/17/2023]
Abstract
Urinary tract infections (UTIs) are one of the most common infections and affect up to 50% of women in their lifetime, with almost half of these women experiencing a recurrence in 6-12 months. Menopause predisposes women to recurrent UTI (rUTI), as normally lower levels of estrogen lead to changes in the urogenital epithelium and subsequently urogenital microbiome. The recently discovered urobiome is now known to have different compositions in both healthy and unhealthy bladders, including a role in the pathophysiology of rUTI, and may be a therapeutic target for prevention and treatment options for rUTI. In postmenopausal women with frequent UTI, the diagnosis of acute UTI should be made using a combination of the symptom assessment and urine diagnostic studies. The choice of UTI antibiotic should include consideration of efficacy, collateral effects, and side-effects. Some women may be candidates for self-start therapy, in which the patient accurately recognizes her UTI symptoms and then starts previously prescribed antibiotics. A large component of the management of women with rUTI is prevention. Urobiome research for bladder health and disease is a young field of investigation with significant potential to improve care for postmenopausal women affected by rUTI through novel, evidence-based prevention and treatment strategies.
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Affiliation(s)
- Carrie Jung
- a Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery , University of California San Diego , La Jolla , CA , USA
| | - Linda Brubaker
- a Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery , University of California San Diego , La Jolla , CA , USA
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Dillman JR, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, Brown BP, Chan SS, Dorfman SR, Falcone RA, Garber MD, Nguyen JC, Peters CA, Safdar NM, Trout AT, Karmazyn BK. ACR Appropriateness Criteria ® Hematuria-Child. J Am Coll Radiol 2019; 15:S91-S103. [PMID: 29724430 DOI: 10.1016/j.jacr.2018.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 02/01/2023]
Abstract
Hematuria is the presence of red blood cells in the urine, either visible to the eye (macroscopic hematuria) or as viewed under the microscope (microscopic hematuria). The clinical evaluation of children and adolescents with any form of hematuria begins with a meticulous history and thorough evaluation of the urine. The need for imaging evaluation depends on the clinical scenario in which hematuria presents, including the suspected etiology. Ultrasound and CT are the most common imaging methods used to assess hematuria in children, although other imaging modalities may be appropriate in certain instances. This review focuses on the following clinical variations of childhood hematuria: isolated hematuria (nonpainful, nontraumatic, and microscopic versus macroscopic), painful hematuria (ie, suspected nephrolithiasis or urolithiasis), and renal trauma with hematuria (microscopic versus macroscopic). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jonathan R Dillman
- Principal Author, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Cynthia K Rigsby
- Panel Chair, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ramesh S Iyer
- Panel Vice Chair, Seattle Children's Hospital, Seattle, Washington
| | | | | | - Brandon P Brown
- Riley Hospital for Children Indiana University, Indianapolis, Indiana
| | | | | | - Richard A Falcone
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; American Pediatric Surgical Association
| | - Matthew D Garber
- Wolfson Children's Hospital, Jacksonville, Florida; American Academy of Pediatrics
| | - Jie C Nguyen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Craig A Peters
- UT Southwestern Medical Center, Dallas, Texas; Society for Pediatric Urology
| | | | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Boaz K Karmazyn
- Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana
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Rossi SH, Prezzi D, Kelly-Morland C, Goh V. Imaging for the diagnosis and response assessment of renal tumours. World J Urol 2018; 36:1927-1942. [PMID: 29948048 PMCID: PMC6280818 DOI: 10.1007/s00345-018-2342-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/15/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Imaging plays a key role throughout the renal cell carcinoma (RCC) patient pathway, from diagnosis and staging of the disease, to the assessment of response to therapy. This review aims to summarise current knowledge with regard to imaging in the RCC patient pathway, highlighting recent advances and challenges. METHODS A literature review was performed using Medline. Particular focus was paid to RCC imaging in the diagnosis, staging and response assessment following therapy. RESULTS Characterisation of small renal masses (SRM) remains a diagnostic conundrum. Contrast-enhanced ultrasound (CEUS) has been increasingly applied in this field, as have emerging technologies such as multiparametric MRI, radiomics and molecular imaging with 99mtechnetium-sestamibi single photon emission computed tomography/CT. CT remains the first-line modality for staging of locoregional and suspected metastatic disease. Although the staging accuracy of CT is good, limitations in determining nodal status persist. Response assessment following ablative therapies remains challenging, as reduction in tumour size may not occur. The pattern of enhancement on CT may be a more reliable indicator of treatment success. CEUS may also have a role in monitoring response following ablation. Response assessments following anti-angiogenic and immunotherapies in advanced RCC is an evolving field, with a number of alternative response criteria being proposed. Tumour response patterns may vary between different immunotherapy agents and tumour types; thus, future response criteria modifications may be inevitable. CONCLUSION The diagnosis and characterisation of SRM and response assessment following targeted therapy for advanced RCC are key challenges which warrant further research.
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Affiliation(s)
- Sabrina H Rossi
- Academic Urology Group, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Davide Prezzi
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Christian Kelly-Morland
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Vicky Goh
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
- Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
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Töpker M. [Painless hematuria: diagnostic workup using multislice computertomography]. Radiologe 2018; 58:894-899. [PMID: 30178395 DOI: 10.1007/s00117-018-0446-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multislice computed tomography (MSCT) is the current standard in the work-up of hematuria. The examination protocol should be as accurate as possible while avoiding unnecessary exposure to ionizing radiation. OBJECTIVE To present opportunities to reduce the overall radiation dose by tailoring examination protocols to the clinical requirements. METHODS A four-phase MSCT protocol is an accurate tool to diagnose the cause of unclear hematuria in the majority of cases. In patients younger than 30 years and in patients younger than 40 years presenting only with microhematuria, the use a noncontrast low-dose scan is adequate. In addition, patients younger than 50 years may not require precontrast and a late-phase CT scans. Another opportunity to omit acquisitions is a combination of different phases by using the so-called split bolus injection protocol, where the administration of contrast is performed 10 min before the scan and the portal-venous phase and the late phase are combined. If dual energy is available, the precontrast scan can be calculated from the enhanced series. For the evaluation of a renal cyst, a two-phase CT protocol is sufficient to obtain diagnostic information.
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Affiliation(s)
- M Töpker
- Diagnosezentrum Favoriten, Am Hauptbahnhof 2/4, 1100, Wien, Österreich.
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Bignall ONR, Dixon BP. Management of Hematuria in Children. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2018; 4:333-349. [PMID: 30128264 PMCID: PMC6097192 DOI: 10.1007/s40746-018-0134-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose of Review This paper provides a review of the diagnostic evaluation of both microscopic and gross hematuria, as well as an update on the pathogenesis, clinical features, and treatment strategies for several diseases of the kidneys and urinary tract in which hematuria is a prominent finding. The goal is to provide pediatric providers with a framework through which appropriate and expeditious referral to subspecialty care may be made for definitive treatment. Recent Findings Although there has been great heterogeneity in published treatment strategies for many causes of hematuria, the Kidney Diseases Improving Global Outcomes (KDIGO) initiative has recently set forth guidelines for glomerular diseases in particular to provide evidence-based strategies for treatment. In addition, recent advances in the understanding of molecular pathogenesis and long-term clinical outcomes for other non-glomerular diseases has led to updates in treatment strategies summarized in this review. Summary As the pediatric primary care provider is often the first point of contact for children with microscopic or gross hematuria, updated knowledge as to the epidemiology and management of several of the various causes of hematuria will improve the care of children by both avoiding extraneous testing and interventions and implementing definitive care (either by expectant management and reassurance or by subspecialty referral) in a timely manner.
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Affiliation(s)
- O N Ray Bignall
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center
| | - Bradley P Dixon
- Renal Section, Department of Pediatrics, University of Colorado School of Medicine
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Multidetector Computed Tomographic Urography (MDCTU): Its Practical Role in Diagnosis of Upper Tract Urothelial Cancer in Patients 50 years and Older with Different Types of Hematuria. Pathol Oncol Res 2017; 25:249-254. [DOI: 10.1007/s12253-017-0333-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
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Contreras-García R, García-Perdomo HA. Diagnóstico, evaluación y seguimiento de la hematuria microscópica. Un enfoque al alcance de todos. Rev Urol 2016. [DOI: 10.1016/j.uroco.2015.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Moloney F, Murphy KP, Twomey M, O'Connor OJ, Maher MM. Haematuria: an imaging guide. Adv Urol 2014; 2014:414125. [PMID: 25136357 PMCID: PMC4124848 DOI: 10.1155/2014/414125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 11/23/2022] Open
Abstract
This paper discusses the current status of imaging in the investigation of patients with haematuria. The physician must rationalize imaging so that serious causes such as malignancy are promptly diagnosed while at the same time not exposing patients to unnecessary investigations. There is currently no universal agreement about the optimal imaging work up of haematuria. The choice of modality to image the urinary tract will depend on individual patient factors such as age, the presence of risk factors for malignancy, renal function, a history of calculus disease and pregnancy, and other factors, such as local policy and practice, cost effectiveness and availability of resources. The role of all modalities, including conventional radiography, intravenous urography/excretory urography, ultrasonography, retrograde pyelography, multidetector computed tomography urography (MDCTU), and magnetic resonance urography, is discussed. This paper highlights the pivotal role of MDCTU in the imaging of the patient with haematuria and discusses issues specific to this modality including protocol design, imaging of the urothelium, and radiation dose. Examination protocols should be tailored to the patient while all the while optimizing radiation dose.
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Affiliation(s)
- Fiachra Moloney
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Kevin P. Murphy
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Maria Twomey
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Owen J. O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Michael M. Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
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In search of a consensus: evaluation of the patient with hematuria in an era of cost containment. AJR Am J Roentgenol 2014; 202:1179-86. [PMID: 24848814 DOI: 10.2214/ajr.13.12266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the current consensus guidelines for nonimaging triage and ultimate preferred imaging approach for the patient with unexplained hematuria. CONCLUSION Numerous consensus guidelines from varying societies have outlined preferred imaging pathways for the patient with unexplained urologic causes of hematuria. Future guidelines will need to take into account disease prevalence, radiation considerations, and cost.
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Cakmakci E, Bayram A, Turkoglu OK, Ozal ST, Celebi I, Cakmakci S, Seker H, Aydin MZ, Aydin A, Kitirci G. Correlation between computerized tomography density measurements of urinary bladder and urinalysis results. Clin Imaging 2014; 38:283-6. [PMID: 24556331 DOI: 10.1016/j.clinimag.2014.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/27/2013] [Accepted: 01/06/2014] [Indexed: 11/28/2022]
Abstract
Our aim was to investigate whether there is a correlation between computerized tomography (CT) density measurements of the urinary bladder and urinalysis results. Patients were subdivided into three groups with respect to urinalysis results: Group 1, no leukocytes or erythrocytes detected in urine (n=25); Group 2, erythrocytes detected in urine (n=50); and Group 3, leukocytes and erythrocytes detected in urine (n=98). In CT sections, densitometric measurements had been performed from three zones on each section and groups were compared in terms of densitometry results. Our results indicate that density measurements of CT views form the urinary bladder may provide valuable data on hematuria and leukocyturia.
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Affiliation(s)
- Emin Cakmakci
- Department of Radiology, Kelkit Government Hospital, Gumushane, Turkey.
| | - Aysel Bayram
- Department of Radiology, Bafra Government Hospital, Samsun, Turkey
| | - Ozlem Kolcak Turkoglu
- Department of Radiology, Dr. Lutfu Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Safiye Tokgoz Ozal
- Department of Radiology, Dr. Lutfu Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Irfan Celebi
- Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Selma Cakmakci
- Department of Pediatrics, Division of Heamatology and Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Hulya Seker
- Department of Pediatrics, Kelkit Government Hospital, Gumushane, Turkey
| | - Mehmet Zeki Aydin
- Department of Internal Medicine, Kelkit Government Hospital, Gumushane, Turkey
| | - Alper Aydin
- Department of Radiology, Giresun Prof. Dr. Ilhan Ozdemir Government Hospital, Giresun, Turkey
| | - Gurcan Kitirci
- Department of Urology, Kelkit Government Hospital, Gumushane, Turkey
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MDCT evaluation of ureteral tumors: advantages of 3D reconstruction and volume visualization. AJR Am J Roentgenol 2014; 201:1239-47. [PMID: 24261362 DOI: 10.2214/ajr.13.10880] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This article reviews the use of CT urography in diagnosing ureteral transitional cell carcinomas, different CT urography protocols, CT findings suggestive of ureteral malignancy, and the importance of 3D reconstructions. CONCLUSION The ureters can be problematic to evaluate on CT, partly because of difficulties in obtaining adequate ureteral distention and opacification. Proper diagnosis hinges not only on appropriate interpretation of the axial images but also on the utilization of a 3D technique (volume rendering or maximum intensity projection) as an ancillary tool.
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Huang LK, Wang JH, Shen SH, Lin ATL, Chang CY. Evaluation of the extent of ketamine-induced uropathy: the role of CT urography. Postgrad Med J 2014; 90:185-90. [PMID: 24443558 PMCID: PMC3963547 DOI: 10.1136/postgradmedj-2013-131776] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND With growing ketamine abuse, ketamine-induced uropathy (KIU) has become more prevalent in recent years. This research evaluates the presence, distribution and extent of KIU in the upper and lower urinary tracts by retrospectively reviewing CT urography (CTU) images. METHODS Patients diagnosed with KIU who underwent CT scanning from 1 January 2006 to 31 December 2011 were recruited. The CT protocols included three-phase CTU in six patients, split-bolus CTU in 17, two-phase CT in one and unenhanced CT in three. The CT images were retrospectively reviewed by two radiologists. RESULTS A total of 27 patients participated in this study. The common CT findings included diffuse bladder wall thickening (88.9%), small bladder volume (66.7%) and perivesical inflammation (44.4%). Twelve patients (44.4%) were diagnosed with hydronephrosis, including three patients with unilateral hydronephrosis and nine with bilateral hydronephrosis. Of these patients, nine had ureteral wall thickening (33.3%) and two (7.4%) had ureterovesical junction involvement (ie, they had hydronephrosis but no ureteral wall thickening). One patient had a ureteral obstruction because of a ureter stone. The correlation between upper urinary tract involvement and grading of the interstitial cystitis was statistically non-significant (p=0.33). Four patients (14.8%) had a vesicovaginal fistula which could be detected in the excretory phase only. CONCLUSIONS Upper urinary tract involvement is common in patients with KIU. CTU might aid evaluation of the extent of KIU and prompt adequate management.
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Affiliation(s)
- Li-Kuo Huang
- Department of Radiology, Taipei Veterans General Hospital, , Taipei, Taiwan
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Hematuria: A Problem-Based Imaging Algorithm Illustrating the Recent Dutch Guidelines on Hematuria. AJR Am J Roentgenol 2012; 198:1256-65. [DOI: 10.2214/ajr.11.8255] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
A distressing complication for patients and families, gross hematuria at the end of life challenges hospice and palliative care clinicians to utilize skills in medical and nursing management, communication and clarification of patient goals, and relief of symptom burden. Massive hemorrhage in the genitourinary tract can radically alter the terminal trajectory for patients and necessitate intensive interventions aimed at promoting comfort. Here, a case of gross hematuria in an adult hospice patient serves to broaching decision-making challenges and management strategies.
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Hematuria evaluation with MDCT urography: is a contrast-enhanced phase needed when calculi are detected in the unenhanced phase? AJR Am J Roentgenol 2011; 197:W84-9. [PMID: 21701000 DOI: 10.2214/ajr.10.5968] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the added utility of the contrast-enhanced phase of MDCT urography (MDCTU) when urinary tract calculi are detected in the preliminary unenhanced phase. MATERIALS AND METHODS A computer search of CT reports with the term "hematuria" yielded the records of 1209 patients who had undergone MDCTU. The reports of 286 MDCTU examinations in which urinary tract calculi were detected were identified, and two blinded abdominal radiologists reviewed the images to find a second source of hematuria. The unenhanced images were reviewed first, and the findings were compared with those on the subsequent contrast-enhanced images. The aggregate findings of the 286 examinations in which calculi were present were compared with those of the 923 examinations in which calculi were absent. The follow-up diagnosis was based on histopathologic findings, findings at urologic procedures, or the imaging diagnosis. RESULTS In 119 of the 1209 patients (10%), 127 lesions other than urinary tract calculi were identified as possible sources of hematuria. Eighty-two lesions were diagnosed in 77 patients (6%) at follow-up evaluation. A second source of hematuria was found in 19 of the 286 examinations (7%) with calculi compared with 58 of the 923 examinations (6%) without calculi (p = 0.828), and contrast was needed to make a specific diagnosis in 16 of the 19 examinations (84%). CONCLUSION When urinary tract calculi are identified at MDCTU, the rate of detection of other potential causes of hematuria is not different from that in MDCTU examinations without calculi. The contrast-enhanced portion of the MDCTU examination is needed even if calculi are seen because important pathologic changes are diagnosed only after the contrast-enhanced phase.
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Abstract
The most common causes of hematuria in adults include urinary tract infections, urolithiasis, benign prostatic enlargement, and urologic malignancy. Once hematuria is confirmed, its cause should be investigated through a comprehensive history, a focused physical examination, laboratory studies, an image-based assessment of the upper urinary tract, and a cystoscopic evaluation of the lower urinary system. Prompt evaluation and appropriate referral of patients with documented hematuria should be initiated in the primary care setting according to the proposed guidelines, and aimed at cost-effective and early detection of urologic abnormality.
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Affiliation(s)
- Vitaly Margulis
- Department of Urology, The University of Texas Southwestern Medical Center, 5339 Harry Hines Boulevard, Dallas, TX 75390-9110, USA.
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Franco A, Tomás M, Alonso-Burgos A. [Intravenous urography is died. Long live the computerized tomography!]. Actas Urol Esp 2010; 34:764-74. [PMID: 20843453 DOI: 10.1016/j.acuro.2010.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Very important changes have happened in the field of the genitourinary image during the last half of the 20th century, so that for most of the historical intravenous urography indications, nowadays the computerized tomography (CT) is technique of choice. The aim of this report is to perform an update in the correct use of the imaging techniques in the adult-related most frequent urological pathology, including: urolithiasis, haematuria, infections, tumours, surgery follow-up and pyelectasis, specially focused in CT. A brief historical review of the urological imaging techniques is performed, emphasizing the physical principles. In the second part, the role played by plain X-ray, ultrasound, CT and MR in the different urological pathologies are reviewed, discussing the sensibility and specificity of each technique. A brief reflection is finally carried out over of the radiation doses.
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Affiliation(s)
- A Franco
- Servicio de Radiología, Fundación Jiménez Díaz, Madrid, España.
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Multi-detector CT urography: effect of oral hydration and contrast medium volume on renal parenchymal enhancement and urinary tract opacification—a quantitative and qualitative analysis. Eur Radiol 2010; 20:2146-52. [DOI: 10.1007/s00330-010-1785-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 01/25/2010] [Accepted: 02/28/2010] [Indexed: 10/19/2022]
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O'Regan KN, O'Connor OJ, McLoughlin P, Maher MM. The Role of Imaging in the Investigation of Painless Hematuria in Adults. Semin Ultrasound CT MR 2009; 30:258-70. [DOI: 10.1053/j.sult.2009.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lucignani G. Beyond haematuria in uro oncology: imaging biomarkers lag behind needs. Eur J Nucl Med Mol Imaging 2008; 36:152-7. [PMID: 19005654 DOI: 10.1007/s00259-008-0993-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Giovanni Lucignani
- Institute of Radiological Sciences, University of Milan, Unit of Nuclear Medicine, San Paolo Hospital, Via Antonio di Rudinì, 8, 20142, Milan, Italy.
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