The role of ultrasound and intravenous urography in evaluating patients with hematuria

Ahmad Noah Hamudi; Ayad Faraj Rasheed

doi:10.15218/zjms.2018.033

Authors

Ahmad Noah Hamudi Department of Radiology, Rizgary Teaching Hospital, Erbil, Iraq
Ayad Faraj Rasheed Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq

DOI:

https://doi.org/10.15218/zjms.2018.033

Keywords:

Hematuria, Ultrasonography, Intravenous urography, Urologic neoplasm, Urinary calculi

Abstract

Background and objective: Intravenous urography is a radiographic examination in which anatomic and physiologic abnormalities of the urinary tract are detected by obtaining a timed series of imaging of the abdomen and pelvis after the injection of intravenous "IV" iodinated contrast media. This study aimed to measure the diagnostic validity of ultrasound and intravenous urography in the hope of omitting unnecessary intravenous urography and to determine whether ultrasound could help to replace the intravenous urography in the diagnosis of hematuria.

Patients and methods: A prospective hospital based study was performed from 15^th April 2015 to 15^th April 2016 on 100 patients presenting to Rizgary Teaching Hospital with hematuria, all patients underwent a real time ultrasound examination of the urinary tract followed by an intravenous urography. The diagnostic validities were recorded and compared for each modality.

Results: Ultrasound had higher sensitivity than intravenous urography for diagnosis of kidney calculi, lower ureteric calculi, and urologic neoplasms, but in calculi of the middle and upper ureter, there was no difference between ultrasound and intravenous urography.

Conclusion: Our results are in favor of using ultrasound in the initial evaluation of hematuria. However, we must choose our diagnostic tool according to the patient's condition and suspected disorders causing hematuria, as ultrasound can be safely done and hence minimizing the exposure of the patient and medical staff to excessive radiation.

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References

Alan J. Wein. Campbell-Walsh Urology. 9th ed. Philadelphia, USA; 2007. P. 56.

Sutton D. Textbook of radiology and imaging, 7th ed. Edinburgh: Churchill Livingstone; 2003. P. 970.

Ryan S, McNicholas M , Eustace S. Anatomy for diagnostic imaging. 2nd ed. Philadelphia: Saunders; 2004.

Drake RL, Vogl W, Mitchell AWM. Gray's Anatomy for Students. Philadelphia: Elsevier; 2005. P. 321–3.

Patel D, Patel U. Role of radiological imaging for the evaluation of hematuria. Trends in Urology and Men's Health 2011; 2(6):15–9.

O'Connor OJ, Fitzgerald E, Maher MM. Imaging of hematuria . Am J Roentgenol 2010; 195 (4):W263–7.

Ramchandani P, Kisler T, Francis IR. Expert Panel on Urologic Imaging. ACR Appropriateness Criteria hematuria. Reston, VA: American College of Radiology; 2008.

Anderson EM, Murphy R, Rennie ATM, Cowan NC. Multidetector computed tomography urography (MDCTU) for diagnosing urothelial malignancy. Clin Radiol 2007; 62:324–32.

Handrigan MT, Thompson I, Foster M. Diagnostic procedures for the urogenital system. Emergency Medical Clinic. North America 2001; 19:745–61.

Miller OF, Rineer SK, Reichard SR, Buckley RG, Donovan MS, Graham IR, et al. Prospective comparison of unenhanced spiral computed tomography and intravenous urogram in the evaluation of acute flank pain. Urology 1998; 52:982–7.

Heneghan JP, Kim DH, Leder RA, DeLong D, Nelson RC. Compression CT urography: a comparison with IVU in the opacification of the collecting system and ureters. J Computed Assist Tomography 2001; 25:343–7.

Stoller M, Meng MV. Urinary stone disease. The practical guide to medical and surgical management 7th ed. New Jersey: Hummana Press; 2002. P. 371.

Ansell G, Beltman MA, Complications in diagnostic imaging and interventional radiology. 3rd ed. Oxford: Black Wall Science; 2004. P. 270.

Ionizing Radiation (medical exposure) regulations 2000, National Radiation Board, United Kingdom; 2000 (accessed August 1, 2016 at http//www.nr.pb.org.UK).

Dawson P, Sidhu PS. Is there a role for corticosteroid prophylaxsis in patients at increased risk of adverse reaction to intravenous contrast agent? Clin Radiol1993; 48(4):225–6.

Novick AC, Campbell SC. Renal tumors. In: Walsh PC, Retik AB, Vaughan ED Jr. Campbell's urology. 8th ed. Philadelphia: WB Saunders; 2002. P. 2672-731.

Rafique M, Javed AA. Role of intravenous urography and transabdominal ultrasonography in the diagnosis of bladder carcinoma. Int Braz J Urol 2004; 30:185–90.

Hoenig DM, McRae S, Chen SC, Diamond DA, Rabinowitz R, Caldamone AA. Transitional cell carcinoma of the bladder in the pediatric patient. J Urol 1996;156:203–5.

Palmer JS, Donaher ER, O'Riordan MA, Dell KM. Diagnosis of pediatric urolithiasis: Role of ultrasound and computerized tomography. J Urol 2005; 174:1413–6.

Middleton WD, Dodds WJ, Lawson TL, Foley WD. Renal calculi: sensitivity for detection with US. Radiology 1988; 167:239–44.

Marumo K, Horiguchi Y, Nakagawa K. Significance and diagnostic accuracy of renal calculi found by ultrasonography in patients with asymptomatic microscopic hematuria. Int J Urol 2002; 9:363–7.

Yilmaz S, Sindel T, Arslan G. Renal colic: comparison of spiral CT, US and IVU in the detection of ureteral calculi. Eur Radiol 1998; 8:212–7.

Henderson SO, Hoffner RJ, Aragona JL, Groth DE, Esekogwu VI, Chan D. Bedside emergency department ultrasonography plus radiography of the kidneys, ureters, and bladder vs intravenous pyelography in the evaluation of suspected ureteral colic. Acad Emerg Med 1998; 5:666–71.

Mokulis JA, Arndt WF, Downey JR, Caballero RL, Thompson IM. Should renal ultrasound be performed in the patient with microscopic hematuria and a normal excretory urogram? J Urol 1995; 154:1300–1.

Scialabba A, Li Vecchi M, Vigneri S. The ultrasonographic examination in hematuria. Evaluation of its diagnostic possibilities. Minerva Urol Nefrol 1992; 44:185–90.