This retrospective study examined the records of 1000 patients attending a haematuria clinic over a two-year period. All patients over 40 with visible (VH) or non-visible haematuria (NVH) had a computed tomography urogram (CTU) and a flexible cystoscopy (if not contra-indicated). Overall there was a tumour pick-up rate of 13%, with a 7% malignancy rate in patients with NVH and 20% in patients with VH. In patients aged over 50 the overall chance of malignancy was 17% compared to 1.7% in those aged 40-49. No upper urothelial tract tumours were identified in patients under 50 and NVH or VH, compared to the over 50 group with VH or NVH where nine such tumours were found (1.3%). Patients were also more likely to have malignancy if they were asymptomatic compared to symptomatic although this result was not statistically significant. The results also show that malignancies can occur in the presence of a proven urinary tract infection with 7.1% incidence in patients with NVH and 21% in patients with VH (the majority of these being bladder tumours). They conclude that in view of the above findings CTU and the increased radiation exposure should be limited to patients over the age of 50 for both NVH and VH. This study shows a lower tumour rate than some previous studies, although the incidence of upper urothelial tract tumours was similar. The conclusion of the study essentially reinforces the advice of the Royal College of Radiologists for the investigation of haematuria i.e. patients under 45 should have a kidney, ureter, bladder (KUB) x-ray and ultrasound (US) for NVH and intravenous urogram (IVU) and US for VH and patients over 45 should have an IVU and US for NVH and a CTU if VH is present.

The evaluation of CT urography in the haematuria clinic.
Bromage SJ, Liew M, Moore K, et al.
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Ann Crump

Central Manchester Foundation NHS Trust

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