부산대학교 도서관

Recent updates to the AUA Hematuria Guidelines recommend obtaining a renal ultrasound (RUS) for low and intermediate risk patients with microscopic hematuria, and computed tomography (CT) with urographic phase imaging (CTU) for high-risk patients. Motivating factors in decreasing the number of CTU's performed include reducing costs and radiation exposure in patients with lower risk of malignancy diagnosis. While CTU has been shown to have a high diagnostic yield for urothelial carcinoma, there is less data supporting the diagnostic yield of RUS in this population. We sought to evaluate the diagnostic performance of CT, magnetic resonance imaging (MRI), and RUS imaging modalities in a large population of patients with hematuria and no prior urological evaluation. Between 1/1/2020 and 7/15/2023, all patients with hematuria, defined as;≥;3 red blood cells on high-powered microscopy, diagnosed on urinalysis at a single large academic medical center were retrospectively reviewed. Only patients with urinalyses ordered in the outpatient setting were included (i.e., urinalyses from inpatient and emergency units were excluded). Patients with any prior history of urothelial cancer, ovarian cancer, or CKD-IV were excluded, in addition to patients with a diagnosis of nephrolithiasis, prostate cancer, kidney cancer, kidney transplant, or chemotherapy use within the past 2 years prior to the hematuria event. 5450 patients with a hematuria episode (microhematuria [MH] or gross hematuria [GH]) and no prior urologic evaluation were available for analysis. Imaging studies, cystoscopy status, referrals, and subsequent diagnoses after the hematuria event were collected. 1561 patients with hematuria and no prior urologic evaluation had imaging or cystoscopy data available for analysis. Median patient age was 62 (IQR: 52.0-74.0). Sixty eight percent of patients were female. Fourteen different imaging modalities were identified as part of the hematuria workups. Three percent of patients had cystoscopy alone with no imaging. In patients who only received urographic imaging (386/1561, 25%), patients with AUA low-risk MH were more likely to get RUS than CTU (p=0.001) (Table 1). Eighteen bladder cancer diagnoses were made, primarily with CTU (12/18, 66.7%) and non-contrasted CT abdomen/pelvis (2/18, 11.1%) (Table 2). Seven kidney cancers were identified: 6/7 (85.7%) on CT imaging and 1/7 (14.3%) on MRI. Notably, no diagnoses of bladder or kidney cancers were made on RUS. Within the database, 219 RUS were performed and associated with 27 diagnoses: 16 urinary tract infections, 9 kidney/ureteral stones, and 2 prostate cancers. This large retrospective review revealed significant variability in imaging studies ordered for hematuria workups in patients not previously seen by Urology. CT and MR imaging showed the highest diagnostic yield for both bladder and kidney cancers, but these were frequently ordered without urographic phase imaging. Zero bladder or kidney cancers were diagnosed on the 219 RUS performed in this group. Further studies are needed to validate the utility and diagnostic yield of RUS in the workup of hematuria, particularly in low and intermediate risk patients. [ABSTRACT FROM AUTHOR]