Skip to main content
NCBI home page
The BMJ logoLink to The BMJ
. 1990 Nov 10;301(6760):1074–1076. doi: 10.1136/bmj.301.6760.1074

Ultrasonography compared with intravenous urography in the investigation of adults with haematuria.

J Spencer 1, D Lindsell 1, I Mastorakou 1
PMCID: PMC1664237  PMID: 2249070

Abstract

OBJECTIVE--To compare ultrasonography with intravenous urography in the investigation of adults with haematuria. DESIGN--Prospective study entailing the examination of all patients with both investigations concurrently. The investigations were performed independently on routine lists by different duty radiologists. Each was aware of the details of the request form but not of the findings of the other investigation. SETTING--Radiology department of a teaching hospital. PATIENTS--155 Consecutive adult patients (aged 18-93) referred from general practitioners and hospital outpatient clinics with a history of haematuria. FOLLOW UP--When results of both examinations proved normal no clinical or radiological follow up was sought. All abnormal findings of either investigation were correlated with results of subsequent imaging studies or operative findings. RESULTS--81 Patients (52%) had normal findings on urography and ultrasonography. Overall, the findings of ultrasonography concurred with those of urography in 144 cases (93%). Among the discrepant findings of the two investigations ultrasonography missed two ureteric calculi; one was in a non-dilated ureter, and in the other case ultrasonography detected the secondary ureteric dilatation. Ultrasound examination alone detected four bladder tumours not visible on urography with sizes ranging from 5 to 21 mm, representing one fifth of the 20 cystoscopically proved bladder tumours detected in the series. Ultrasonography detected all the 22 neoplastic lesions discovered in the study (20 bladder, two renal). Ultrasonography clarified the nature of renal masses evident in three urograms (simple cysts). CONCLUSIONS--Ultrasonography is a safe and accurate method of investigating the urinary tract in adults with haematuria. When combined with a single plain abdominal radiograph it proved to be superior to urography as the primary imaging study in this series. Ultrasonography should certainly be preferred to urography if cystoscopy is not planned. No urothelial tumours of the upper urinary tract were found in the series, reflecting their rarity. For those patients in whom ultrasonography and plain radiography have shown no abnormality and in whom cystoscopic appearances are normal urography would be advisable to exclude urothelial tumours of the upper urinary tract.

Full text

PDF
1074

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abu-Yousef M. M., Narayana A. S., Franken E. A., Jr, Brown R. C. Urinary bladder tumors studied by cystosonography. Part I: Detection. Radiology. 1984 Oct;153(1):223–226. doi: 10.1148/radiology.153.1.6473785. [DOI] [PubMed] [Google Scholar]
  2. Abuelo J. G. The diagnosis of hematuria. Arch Intern Med. 1983 May;143(5):967–970. [PubMed] [Google Scholar]
  3. Alon U., Pery M., Davidai G., Berant M. Ultrasonography in the radiologic evaluation of children with urinary tract infection. Pediatrics. 1986 Jul;78(1):58–64. [PubMed] [Google Scholar]
  4. Britton J. P., Dowell A. C., Whelan P. Dipstick haematuria and bladder cancer in men over 60: results of a community study. BMJ. 1989 Oct 21;299(6706):1010–1012. doi: 10.1136/bmj.299.6706.1010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Corwin H. L., Silverstein M. D. The diagnosis of neoplasia in patients with asymptomatic microscopic hematuria: a decision analysis. J Urol. 1988 May;139(5):1002–1006. doi: 10.1016/s0022-5347(17)42747-9. [DOI] [PubMed] [Google Scholar]
  6. Davies A. H., Cranston D., Meagher T., Fellows G. J. Detection of recurrent bladder tumours by transrectal and abdominal ultrasound compared with cystoscopy. Br J Urol. 1989 Oct;64(4):409–411. doi: 10.1111/j.1464-410x.1989.tb06053.x. [DOI] [PubMed] [Google Scholar]
  7. Erwin B. C., Carroll B. A., Sommer F. G. Renal colic: the role of ultrasound in initial evaluation. Radiology. 1984 Jul;152(1):147–150. doi: 10.1148/radiology.152.1.6729105. [DOI] [PubMed] [Google Scholar]
  8. Fidas A., Mackinlay J. Y., Wild S. R., Chisholm G. D. Ultrasound as an alternative to intravenous urography in prostatism. Clin Radiol. 1987 Sep;38(5):479–482. doi: 10.1016/s0009-9260(87)80128-9. [DOI] [PubMed] [Google Scholar]
  9. Grace D. A., Taylor W. N., Taylor J. N., Winter C. C. Carcinoma of the renal pelvis: a 15-year review. J Urol. 1967 Nov;98(5):566–569. doi: 10.1016/S0022-5347(17)62933-1. [DOI] [PubMed] [Google Scholar]
  10. Lewis-Jones H. G., Lamb G. H., Hughes P. L. Can ultrasound replace the intravenous urogram in preliminary investigation of renal tract disease? A prospective study. Br J Radiol. 1989 Nov;62(743):977–980. doi: 10.1259/0007-1285-62-743-977. [DOI] [PubMed] [Google Scholar]
  11. Lindsell D., Moncrieff M. Comparison of ultrasound examination and intravenous urography after a urinary tract infection. Arch Dis Child. 1986 Jan;61(1):81–82. doi: 10.1136/adc.61.1.81. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Lucas M. G., Bodley R. N., Lindsell D. R., Fletcher E. W., Scott N. P. Urography prior to prostatectomy. Postgrad Med J. 1986 Dec;62(734):1117–1119. doi: 10.1136/pgmj.62.734.1117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Middleton W. D., Dodds W. J., Lawson T. L., Foley W. D. Renal calculi: sensitivity for detection with US. Radiology. 1988 Apr;167(1):239–244. doi: 10.1148/radiology.167.1.3279456. [DOI] [PubMed] [Google Scholar]
  14. Mohr D. N., Offord K. P., Owen R. A., Melton L. J., 3rd Asymptomatic microhematuria and urologic disease. A population-based study. JAMA. 1986 Jul 11;256(2):224–229. [PubMed] [Google Scholar]
  15. Virji A. A study of patients attending without appointments in an urban general practice. BMJ. 1990 Jul 7;301(6742):22–26. doi: 10.1136/bmj.301.6742.22. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Warshauer D. M., McCarthy S. M., Street L., Bookbinder M. J., Glickman M. G., Richter J., Hammers L., Taylor C., Rosenfield A. T. Detection of renal masses: sensitivities and specificities of excretory urography/linear tomography, US, and CT. Radiology. 1988 Nov;169(2):363–365. doi: 10.1148/radiology.169.2.3051112. [DOI] [PubMed] [Google Scholar]
  17. Williams C. B., Mitchell J. P. Carcinoma of the renal pelvis: a review of 43 cases. Br J Urol. 1973 Aug;45(4):370–376. doi: 10.1111/j.1464-410x.1973.tb12174.x. [DOI] [PubMed] [Google Scholar]
  18. Williams C. B., Mitchell J. P. Carcinoma of the ureter--a review of 54 cases. Br J Urol. 1973 Aug;45(4):377–387. doi: 10.1111/j.1464-410x.1973.tb12175.x. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES