Intravenous urography in evaluation of asymptomatic microscopic hematuria.
OBJECTIVE
In 2001, the American Urologic Association Best Practice Policy Panel recommended CT or intravenous urography (IVU) over ultrasonography as the initial imaging modality in patients with asymptomatic microhematuria. We here present results of a study initiated many years ago and completed prior to 2001 that provides information pertinent to the use of IVU as the initial imaging modality for such patients.


METHODS
This study compared the results of IVU and ultrasonography in patients 40+ years of age who were referred to a single urology department for evaluation of microscopic hematuria between 1994 and 2000. There were 290 patients who agreed to participate by undergoing ultrasonography in addition to IVU; 247 completed both tests. There were 81 men and 166 women with a mean age of 56.4 years (range 40-86 years). Thirty patients (12%) were smokers.


RESULTS
A renal lesion or mass suggestive of tumor was found in 8 patients (3.2%); 3 patients had this finding on the IVU examination and 5 on ultrasonography. None of the patients had such a lesion/mass on both examinations. Two patients with suspect lesions were ultimately found to have renal-cell carcinoma. Both of the patients with renal cancer had a suspect lesion on the ultrasound examination but not on the contemporaneous IVU.


CONCLUSIONS
Intravenous urography may miss lesions/masses that lead to a diagnosis of upper-tract neoplasia.
Department of Urology, Los Angeles Medical Center, Los Angeles, California 90027, USA.
Armen H
AH
Dikranian
Diana B
DB
Petitti
Charles E
CE
Shapiro
Anne F
AF
Kosco
D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging*; D003951:Diagnostic Errors; D005260:Female; D006417:Hematuria / Q000000981:diagnostic imaging*; D006801:Humans; D007275:Injections, Intravenous; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D014463:Ultrasonography; D014567:Urography / Q000379:methods* / Q000592:standards*