CT urography as the first line investigation for haematuria: is it truly indicated? A single centre analysis of the use of CT urography in the haematuria clinic

Abstract

Introduction:

Computed tomographic urography (CTU) is gaining popularity as the first line investigation for haematuria. It can be used to produce a ‘true’ one-stop clinical assessment. However, a large number of investigations can be negative, exposing patients to a number of risks.

Objective:

We set out to evaluate the use of CTU in our one-stop haematuria clinic to see if it supported the utilisation of CTU as a triage investigation for haematuria.

Methods:

Retrospective analysis of all CT urograms performed (508) in our trust in 2013 took place. CTUs requested from the haematuria clinic were identified and analysed further.

Results:

A total of 1086 patients attended the haematuria clinic in 2013. 168 males and 78 females (median age 64, range 25 to 90) went on to have further CTU investigation after ultrasonography (USS) and cystoscopy. Visible haematuria (VH) was reported in 95% of cases. All 9 confirmed cases of upper tract urothelial carcinoma lesions presented with VH (age > 50); 8 out of 9 had reported hydronephrosis on USS. The overall negative predictive CTU rate was 96%.

Conclusion:

Our results show that a large number of CTUs are negative. The use of risk stratification, with particular emphasis on the ultrasonography result, gives adequate guidance on the cases that require further CTU investigation, supportive of the current European Association of Urology guidelines. Our results do not support the use of CTU as a first line or triage investigation for haematuria.