A clear history of lower urinary tract haematuria does not always require extensive radiological investigation of the upper urinary tract
BAUS ePoster online library. Stewart H. Jun 26, 2018; 211353
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Ms. Heather Stewart
Ms. Heather Stewart
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Abstract
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Introduction: We investigated the incidence of upper urinary tract (UUT) abnormalities in males with initial and/or terminal visible haematuria (VH) suggesting a lower urinary tract (LUT) cause. Is extensive UUT imaging really necessary?

Materials/Method: Two-armed (retrospective (n=419) and prospective (n=1173)) study of all consecutive male patients with VH over 5 years. All patients underwent flexible cystoscopy (FC) and UUT imaging (USS+/-IVU/CT urogram). Those with initial and/or terminal VH were scrutinised further.

Results: 62/419 (14.8%) of patients in the retrospective group (R-G) and 183/1173 (15.6%) in the prospective group (P-G) presented with initial and/or terminal VH. In the R-G, FC revealed these LUT abnormalities: 4 bladder calculi; 3 bladder tumours; 1 urethral stricture. Only one UUT malignancy was identified (single case of renal cell carcinoma detected on USS and IVU). In the P-G, 129/183 patients underwent CT and 75 had an USS. 178/183 had a FC with these findings: 70 large/vascular prostates (38.3%); 25 bladder tumours (13.7%); 16 urethral strictures (8.7%); 1 bladder neck stenosis and 66 normal inspections (36.1%). UUT imaging demonstrated an abnormality in 13 (7.1%) patients (5 non-obstructing renal calculi; 4 angiomyolipoma; 2 hydronephrosis due to known bladder tumour; 1 polycystic kidney disease; 1 known/pre-existing tumour.) No new UUT malignancies were identified in 183 patients.

Conclusions: Patients with an exclusive history of initial and/or terminal VH do not require extensive UUT imaging due to the low incidence of serious UUT pathology. FC and USS (rather than CT) may suffice, also reducing inconvenience, radiation exposure and healthcare costs.
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