Prospective comparison of computerized tomography and excretory urography in the initial evaluation of asymptomatic microhematuria.
OBJECTIVE
The ideal imaging study for evaluation of the upper urinary tract in patients with microhematuria has been debated. We prospectively compared the diagnostic yield of computerized tomography (CT) to excretory urography (IVP) in the initial evaluation of asymptomatic microhematuria.


METHODS
Between December 1998 and June 2001, 115 patients presenting with asymptomatic microhematuria underwent CT and IVP before cystoscopy. Helical CT images with 5 mm. adrenal and kidney slices with and without contrast material were followed by delayed 5 mm. ureteral contrast images through the bladder base. Each CT and IVP was examined by a radiologist who was blinded to the result of the other imaging study. Diagnostic yields of the imaging techniques were compared using the test of 2 proportions and chi-square analysis.


RESULTS
Radiographic abnormalities were noted on CT or IVP in 38 patients. Sensitivity was 100% for CT and 60.5% for IVP, and specificity 97.4% for CT and 90.9% for IVP. CT accuracy was 98.3% compared to IVP accuracy which was 80.9% (p <0.001). A total of 40 nonurological diagnoses were made by CT, including 3 abdominal aortic aneurysms and 1 iliac artery aneurysm. No additional diagnoses were made by IVP. Fewer additional radiographic studies were recommended after CT than after IVP.


CONCLUSIONS
The use of CT in the initial evaluation of asymptomatic microhematuria results in better diagnostic yield. In addition, more nonurological diagnoses can be made and less additional radiography is needed to confirm a diagnosis.
Gray Sears
Christine L
CL
Department of Urology, Naval Medical Center San Diego, California, USA.
Ward
John F
JF
Sears
Stephen T
ST
Puckett
Michael F
MF
Kane
Christopher J
CJ
Amling
Christopher L
CL
D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging; D003365:Costs and Cost Analysis; D005260:Female; D006417:Hematuria / Q000000981:diagnostic imaging / Q000191:economics / Q000209:etiology*; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging; D007680:Kidney Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics; D014545:Urinary Calculi / Q000150:complications / Q000000981:diagnostic imaging; D014567:Urography / Q000191:economics