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Initial imaging evaluation of hydronephrosis of unknown etiology is a complex subject and is dependent on clinical context. In asymptomatic patients, it is often best conducted via CT urography (CTU) without and with contrast, MR urography (MRU) without and with contrast, or scintigraphic evaluation with mercaptoacetyltriglycine (MAG3) imaging. For symptomatic patients, CTU without and with contrast, MRU without and with contrast, MAG3 scintigraphy, or ultrasound of the kidneys and bladder with Doppler imaging are all viable initial imaging studies. In asymptomatic pregnant patients, nonionizing imaging with US of the kidneys and bladder with Doppler imaging is preferred. Similarly, in symptomatic pregnant patients, US of the kidneys and bladder with Doppler imaging or MRU without contrast is the imaging study of choice, as both ionizing radiation and gadolinium contrast are avoided in pregnancy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

A Computed Tomography Urography (CTU) scan is a medical imaging test that examines the urinary tract, including the bladder, kidneys, and ureters. It helps diagnose various urinary tract diseases with precision. However, patients undergoing CTU imaging receive a relatively high dose of radiation, which can be a concern. In our research paper, we analyzed the Computed Tomography Dose Index (CTDIvol) and Dose-Length Product (DLP) for 203 adult patients who underwent CTU at one of the most important regional centers in Bosnia and Herzegovina that sees a large number of patients. Our study included the distribution of age and sex, the number of phases within one examination, and different clinical indications. We compared our findings with the results available in the scientific literature, particularly the recently published results from 20 European countries. Furthermore, we established the local diagnostic reference levels (LDRLs) that can help set the national diagnostic reference levels (NDRLs). We believe our research is a significant step towards optimizing the protocols used in different hospitals in our country. [ABSTRACT FROM AUTHOR]

Purpose: To explore the feasibility of measuring glomerular filtration rate (GFR) using iodine maps in dual-energy spectral computed tomography urography (DEsCTU) and correlate them with the estimated GFR (eGFR) based on the equation of creatinine-cystatin C. Materials and methods: One hundred and twenty-eight patients referred for DEsCTU were retrospectively enrolled. The DEsCTU protocol included non-contrast, nephrographic, and excretory phase imaging. The CT-derived GFR was calculated using the above 3-phase iodine maps (CT-GFRiodine) and 120 kVp-like images (CT-GFR120kvp) separately. CT-GFRiodine and CT-GFR120kvp were compared with eGFR using paired t-test, correlation analysis, and Bland–Altman plots. The receiver operating characteristic curves were used to test the renal function diagnostic performance with CT-GFR120kvp and CT-GFRiodine. Results: The difference between eGFR (89.91 ± 18.45 ml·min−1·1.73 m−2) as reference standard and CT-GFRiodine (90.06 ± 20.89 ml·min−1·1.73 m−2) was not statistically significant, showing excellent correlation (r = 0.88, P < 0.001) and agreement (± 19.75 ml·min−1·1.73 m−2, P = 0.866). The correlation between eGFR and CT-GFR120kvp (66.13 ± 19.18 ml·min−1·1.73 m−2) was poor (r = 0.36, P < 0.001), and the agreement was poor (± 40.65 ml·min−1·1.73 m−2, P < 0.001). There were 62 patients with normal renal function and 66 patients with decreased renal function based on eGFR. The CT-GFRiodine had the largest area under the curve (AUC) for distinguishing between normal and decreased renal function (AUC = 0.951). Conclusion: The GFR can be calculated accurately using iodine maps in DEsCTU. DEsCTU could be a non-invasive and reliable one-stop-shop imaging technique for evaluating both the urinary tract morphology and renal function. [ABSTRACT FROM AUTHOR]

Abstract Objectives To perform a descriptive analysis of a series of patients with recurrent macroscopic haematuria after a primary standard evaluation including computed tomography urography (CTU) and cystoscopy negative for urinary bladder cancer (UBC) and upper tract urothelial cancer (UTUC) and to identify potential factors associated with occurrence of recurrent macroscopic haematuria. Methods All patients older than 50 years who underwent urological investigation for macroscopic haematuria with both cystoscopy and CTU 2015–2017 were retrospectively reviewed. A descriptive analysis of the primary and later investigations for recurrent macroscopic haematuria was performed. To investigate the association between explanatory variables and the occurrence of recurrent macroscopic haematuria, a Poisson regression analysis was performed. Results A total of 1395 eligible individuals with primary standard investigation negative for UBC and UTUC were included. During a median follow‐up of 6.2 (IQR 5.3–7) years, 248 (18%) patients had recurrent macroscopic haematuria, of whom six patients were diagnosed with UBC, two with prostate cancer, one with renal cell carcinoma and one had a suspected UTUC at the repeated investigation. Within 3 years, 148 patients (11%) experienced recurrent macroscopic haematuria, of whom two patients were diagnosed with low‐grade UBC (TaG1–2), one with T2G3 UBC and one with low‐risk prostate cancer. The presence of an indwelling catheter, use of antithrombotic medication, pathological findings at CTU or cystoscopy or history of pelvic radiotherapy were all statistically significant independent predictors for increased risk for recurrent macroscopic haematuria. Conclusion In the case of recurrent macroscopic haematuria within 3 years of primary standard evaluation for urinary tract cancer, there was a low risk of later urological malignancies in patients initially negative for UBC and UTUC. Therefore, waiting 3 years before conducting another complete investigation in cases of recurrent macroscopic haematuria might be appropriate.

Purpose: To assess discrepancies in current imaging recommendations for hematuria among North American societies: American College of Radiology (ACR), American Urological Association (AUA), and Canadian Urological Association (CUA). Methods: The latest available ACR Appropriateness Recommendations, AUA guidelines, and CUA guidelines were reviewed. AUA and CUA guidelines imaging recommendations by variants and level of appropriateness were converted to match the style of ACR. Imaging recommendations including modality, anatomy, and requirement for contrast were recorded. Results: Clinical variants included microhematuria without risk factors, microhematuria with risk factors, gross hematuria, and microhematuria during pregnancy. CUA recommends ultrasound kidneys as the first-line imaging study in the first 3 variants; pregnancy is not explicitly addressed. For hematuria without risk factors, ACR does not routinely recommend imaging, while AUA recommends shared decision-making to decide repeat urinalysis versus cystoscopy with ultrasound kidneys. For hematuria with risk factors and gross hematuria, ACR recommends CT urography; MR urography can also be considered in gross hematuria. AUA further stratifies intermediate- and high-risk patients, for which ultrasound kidneys and CT urography are recommended, respectively. For pregnancy, ACR and AUA both recommend ultrasound kidneys, though AUA additionally recommends consideration of CT or MR urography after delivery. Conclusion: There is no universally agreed upon algorithm for diagnostic evaluation. Discrepancies centered on the role of upper tract imaging with ultrasound versus CT. Prospective studies and/or repeat simulation studies that apply newly updated guidelines are needed to further clarify the role of imaging, particularly for patients with microhematuria with no and intermediate risk factors. [ABSTRACT FROM AUTHOR]

Although tuberculosis most commonly causes thickening and contracture of the urinary bladder, rarely, inflammatory infiltration with central necrosis and perforation may occur. Hereby, the authors present a case report of a 24-year-old man with recurrent spontaneous perforation of the urinary bladder due to tuberculosis. In the first presentation, he recovered well with conservative treatment. In the second presentation, he underwent ileal augmentation cystoplasty, and he did well after the definitive surgery. To the best of authors’ knowledge, this is the first report of recurrent perforation of tuberculous urinary bladder. Perforation of the urinary bladder due to tuberculosis is a rarity, and a high index of clinical suspicion and appropriate investigation is needed for timely diagnosis and treatment.

Purpose To evaluate the sensitivity of corticomedullary-phase imaging for detecting urinary stones in patients with renal colic who visited the emergency department. Materials and Methods This retrospective study included 253 patients with suspected renal colic from two tertiary hospitals in South Korea, who visited the emergency department and underwent CT urography. Two radiologists blinded to the clinical history independently reviewed the corticomedullary- phase images. The sensitivity for identifying urinary stones were evaluated for each reviewer. After the initial evaluation, the images were re-evaluated based on patient history. The sensitivity of re-evaluation were recorded. Results Of 253 patients, 150 (59%) had urinary stones. Among them, significant stones were observed in 138 patients (92%), and obstructive changes on CT in 124 patients (82.7%). For identifying significant urinary stones, the sensitivity was 98.6% (136/138) for both the reviewers. For identifying significant urinary stones with urinary obstruction, the sensitivity was 99.2% (123/124) for reviewer 1, and 100% (124/124) for reviewer 2. The sensitivity for identifying significant stones increased from 98.6% to 100% for reviewer 1, and from 98.6% to 99.3% for reviewer 2 in the re-evaluation session. Conclusion The corticomedullary-phase CT urography was sensitive for diagnosing urolithiasis in patients with acute renal colic who visited the emergency department.

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INTRODUCTION This descriptive cross-sectional study was conducted from June to August 2023, at the Department of Radiodiagnosis & Medical Imaging, Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal, examined a total of fifty-nine patients. The examination protocol comprised triphasic techniques, which included unenhanced, nephrographic, and excretory phases, utilizing a MDCT scanner. The descriptive data were analyzed using SPSS version 20 and presented in the form of a number and percentage. MATERIAL AND METHODS A total 59 patients, 32 were male and 27 were female. Mean age of patients were 44.17±15.66 years, with the majority (28.81%) falling within the age range of 20-30 years. Abdominal pain was the most common symptom (79.66%), followed by hematuria (18.64%). Urolithiasis was the most frequent diagnosis (47.46%), followed by ureterohydronephrosis (22.03%) and hydronephrosis (18.64%). Inflammatory change/infection affected 13.56% of patients, while congenital abnormalities were the least prevalent (3.39%). RESULTS MDCT urography is considered the optimal modality for detecting a broad range of urinary tract abnormalities, due to its utilization of a combination of unenhanced, nephrographic-phase, and excretory-phase imaging techniques. [ABSTRACT FROM AUTHOR]

A Computed Tomography Urography (CTU) scan is a medical imaging test that examines the urinary tract, including the bladder, kidneys, and ureters. It helps diagnose various urinary tract diseases with precision. However, patients undergoing CTU imaging receive a relatively high dose of radiation, which can be a concern. In our research paper, we analyzed the Computed Tomography Dose Index (CTDIvol) and Dose-Length Product (DLP) for 203 adult patients who underwent CTU at one of the most important regional centers in Bosnia and Herzegovina that sees a large number of patients. Our study included the distribution of age and sex, the number of phases within one examination, and different clinical indications. We compared our findings with the results available in the scientific literature, particularly the recently published results from 20 European countries. Furthermore, we established the local diagnostic reference levels (LDRLs) that can help set the national diagnostic reference levels (NDRLs). We believe our research is a significant step towards optimizing the protocols used in different hospitals in our country.

Purpose: Microhematuria is a highly prevalent condition with a low associated risk of urothelial and upper tract malignancy. The AUA Guidelines recently changed recommendations for imaging favoring renal ultrasound for low- and intermediate-risk patients with microhematuria.We summarize the diagnostic test characteristics of computed tomography urography, renal ultrasound, and magnetic resonance urography in comparison with surgical pathology for the diagnosis of upper urinary tract cancer in microhematuria and gross hematuria patients. Materials and Methods: This study is a systematic review and meta-analysis using PRISMA (Preferred Reporting Items for Systematic Reviews and Metaanalyses) guidelines from evidence collected for the 2020 AUA Microhematuria Guidelines report, including studies assessing imaging following diagnosis of hematuria published from January 2010 through December 2019. Results: The search identified 20 studies which reported the prevalence of malignant and benign diagnoses in relation to imaging modality, of which 6 were included in the quantitative analysis. For the detection of renal cell carcinoma and upper urinary tract carcinoma in patients with microhematuria and gross hematuria, computed tomography urography had a sensitivity of 94% (95% CI, 84%-98%) and a specificity of 99% (95%CI, 97%-100%) with a certainty of evidence rating of very low and low, respectively when 4 studies were pooled. In comparison, ultrasound demonstrated a sensitivity ranging from 14%-96% (low certainty of evidence) and a specificity of 99%-100% in 2 studies (moderate certainty of evidence), while magnetic resonance urography demonstrated a sensitivity of 83% and specificity of 86% in 1 study with a low certainty of evidence. Conclusions: In a limited data set for each individual imaging modality, computed tomography urography appears the most sensitive imaging modality for the diagnostic evaluation of microhematuria. Future studies will be needed to evaluate the clinical and health system financial impacts of the change in guideline recommendations from computed tomography urography to renal ultrasound in evaluating low- and intermediate-risk patients with microhematuria. [ABSTRACT FROM AUTHOR]

ObjectiveTo demonstrate our hypothesis that the presence of extravasation on postoperative urethrogram is inconsequential for disease recurrence in urethroplasty postoperative follow-up.Materials and methodsWe utilized the Trauma and Urologic Reconstructive Network of Surgeons database to assess 1691 patients who underwent urethroplasty and post-operative urethrogram. Anatomic and functional recurrence were defined as

Objective: To evaluate whether microscopic hematuria (MH) patients with a negative initial evaluation have an elevated risk for urinary carcinoma. Methods: This is a population-based retrospective study with a matched control identified 8465 adults with an MH ICD code, an initial negative urinary malignancy work-up of cystoscopy and CT urography, and at least 35 months of clinical care. 8465 hematuria naïve controls were age, gender, and smoking status matched. Subsequent coding of non-prostatic urinary cancer, or any following hematuria codes: additional microscopic unspecified or unspecified hematuria, and gross hematuria was obtained. Χ2 tests were performed. Results: There was no statistically significant difference in urinary malignancy rates (p > 0.05). Any urinary cancer: cases 0.74% (63/8465; 95% CI 0.58–0.95%)/controls 0.83% (71/8465; 95% CI 0.66–1.04%%) (p = 0.54); bladder: 0.45%/0.47% (p = 0.82); renal: 0.31%/0.38% (p = 0.43); ureteral: 0.01%/0.02% (p = 0.56). Subsequent gross hematuria in both males and females increased the odds of cancer: males 2.35 (p = 0.001; CI 1.42–3.91); females 4.25 (p < 0.001; CI 1.94–9.34). Males without additional hematuria had decreased odds ratio: 0.32 (p = 0.001; CI 0.16–0.64). Females without additional hematuria 0.58 (p = 0.19; CI 0.26–1.30) and both genders with additional unspecified hematuria/microscopic hematuria males 1.02 (p = 0.97; CI 0.50–2.08) and females 1.00 (p = 0.99; CI 0.38–2.66) did not have increased odds ratios (p > 0.05). Conclusion: MH patients with initial negative evaluation have a subsequent urologic malignancy rate of less than 1% and likely do not need further urinary evaluation unless they develop gross hematuria. [ABSTRACT FROM AUTHOR]

Objective: To investigate the diagnostic value of urography combined with color Doppler in children with congenital hydronephrosis. Methods: A total of 88 children with congenital hydronephrosis treated in our hospital from November 2018 to November 2021 were selected as the study subjects. All children perfectintravenous pyelography and color Doppler ultrasonography, the pathological diagnostic result was used as the gold standard,and the diagnostic value of the two examination methods in children with congenital hydronephrosis was compared. Results: The results of color Doppler ultrasound showed that there were 10, 39 and 39 children with mild, moderate and severe hydronephrosis respectively. Compared with children with different degrees of illness, the peak systolic velocity (PSV） and minimum diastolic velocity (EDV） in the severe group were lower than those in the moderate and mild group, and the blood flow resistance index (RI） in the severe group was higher than those in the moderate and mild group (P＜0.05), but there was no significant difference in PSV, EDV and RI between mild group and moderate group (P＞0.05). Compared with pathological examination results, color Doppler ultrasonography has a high diagnostic performance for children with moderate and severe congenital hydronephrosis, with an accuracy of 90.91% and 93.18%, respectively, and the kappa values compared with pathological diagnosis were 0.795, 0.862, high concordance; but low diagnostic performance for mild hydronephrosis, with a kappa value of 0.629, the consistency is general.The diagnostic results of intravenous pyelography were mild hydronephrosis in 11 cases, moderate hydronephrosis in 37 cases, and severe hydronephrosis in 40 cases; it has high diagnostic efficiency for children with mild congenital hydronephrosis, with an accuracy of 96.59%, and the kappa value compared with pathological diagnosis was 0.824, which has a high consistency; but the diagnostic performance of moderate and severe hydronephrosis is low, and the kappa value distribution were 0.583 and 0.565, and the consistency is general. The diagnostic accuracy of color Doppler ultrasound combined with intravenous pyelography was 94.32%, which was significantly higher than that of the two methods alone (P＜0.05). Conclusion: Different degree of condition of children with congenital hydronephrosis with different ultrasonic signs, color Doppler ultrasound examination for medium and severe hydronephrosis in children with good diagnostic value,while intravenous pyelography is more effective in diagnosing children with mild hydronephrosis. The combination of the two can improve the diagnostic accuracy of congenital hydronephrosis. [ABSTRACT FROM AUTHOR]

Background: Diagnostic imaging is an integral part of the examination of patients with urinary tract pathologies and many imaging modalities are available. Owing to easy accessibility and low cost, radiography used together with ultrasonography as one of the first-step imaging methods in order to visualize the urinary system. Contrast-enhanced radiographic examination of the upper urinary system "intravenous urography" (IVU) can be performed with bolus injection, abdominal compression (with bolus injection) and infusion techniques. The aim of present study was to evaluate the urograms obtained in cats with urinary system complaints, compare the application of the IVU techniques and urogram quality, and interpret their diagnostic efficacy. Materials, Methods & Results: A total of 30 cats (of different age, breed, sex and weight) with urinary system complaint brought to Selcuk University Veterinary Faculty and Balikesir University Veterinary Faculty Surgery Clinics were included in the study. The cats were randomly divided into 3 groups with 10 cats in each group. In these groups, IVU was performed with bolus (Group 1), infusion (Group 2) and abdominal compression with bolus injection (Group 3) techniques. Nonionic monomeric contrast agent iohexol3 (300 mg I/mL, GE Healthcare) at a dose of 800 mg I/kg was administered as an IV bolus injection in the Bolus group; iohexol at a dose of 1200 mg I/kg was diluted in an equal volume of 0.9% NaCl solution and the prepared solution was administered as an IV infusion through the catheter within 10 min in the Infusion group; iohexol at a dose of 800 mg I/kg was administered through the catheter after an elastic compression band was placed around the caudal abdomen to provide compression on the ureters in the bolus injection with abdominal compression group. The contrast agent (iohexol) injection was well tolerated by all cats. None of the cats developed anaphylactoid reactions or anesthesia-related complication. Changes observed in the heart and respiration rates and body temperature during the procedure did not show a statistically significant difference between the groups (P > 0.05). The renal and ureteral opacity scores and groups were compared, there was a significant difference was observed (P < 0.05). Urograms with "1 point" and "2 points" in kidney opacity scores were in the bolus injection group; urograms with "3 points" and "4 points" showed a statistically significant increase in the infusion and abdominal compression groups (P < 0.05). Urograms with "2 points" and "3 points" in ureteral opacity scores did not show a statistically significant difference (P > 0.05). Discussion: Currently, radiological IVU can still be used as a feasible, economical and valuable diagnostic tool with appropriate techniques, contrast agents and dose selection. For this purpose, patient preparation before IVU is very important to increase the interpretation ability of the urograms obtained. Sedation or anesthesia is not required to obtain better urograms. The bolus injection technique would be preferable for evaluating the anatomical position of the kidneys and observing the renal parenchyma. Urograms up to 20 min after the injection in the ventrodorsal (VD) position would be sufficient for proper observation of the nephrography phase. The infusion technique would be preferable for evaluating the collecting system. Urograms up to 20 min following the completion of the infusion in the VD position would be sufficient for proper observation of the pyelography phase and ureters. Urograms should be obtained in the VD and lateral positions for ureteral evaluation. Urograms taken after 5 or 40 min would be sufficient, depending on the ureteral part to be examined. [ABSTRACT FROM AUTHOR]

Purpose: Vesicoureteral reflux grading from voiding cystourethrograms is highly subjective with low reliability. We aimed to demonstrate improved reliability for vesicoureteral reflux grading with simple and machine learning approaches using ureteral tortuosity and dilatation on voiding cystourethrograms. Materials and Methods: Voiding cystourethrograms were collected from our institution for training and 5 external data sets for validation. Each voiding cystourethrogram was graded by 5-7 raters to determine a consensus vesicoureteral reflux grade label and inter- and intra-rater reliability was assessed. Each voiding cystourethrogram was assessed for 4 features: ureteral tortuosity, proximal, distal, and maximum ureteral dilatation. The labels were then assigned to the combination of the 4 features. A machine learning-based model, qVUR, was trained to predict vesicoureteral reflux grade from these features and model performance was assessed by AUROC (area under the receiver-operator-characteristic). Results: A total of 1,492 kidneys and ureters were collected from voiding cystourethrograms resulting in a total of 8,230 independent gradings. The internal inter-rater reliability for vesicoureteral reflux grading was 0.44 with a median percent agreement of 0.71 and low intra-rater reliability. Higher values for each feature were associated with higher vesicoureteral reflux grade. qVUR performed with an accuracy of 0.62 (AUROC[0.84) with stable performance across all external data sets. The model improved vesicoureteral reflux grade reliability by 3.6-fold compared to traditional grading (P < .001). Conclusions: In a large pediatric population from multiple institutions, we show that machine learning-based assessment for vesicoureteral reflux improves reliability compared to current grading methods. qVUR is generalizable and robust with similar accuracy to clinicians but the added prognostic value of quantitative measures warrants further study. [ABSTRACT FROM AUTHOR]

Abstract Background To evaluate the diagnostic accuracy of computed tomography-urography (CTU) to rule out urinary bladder cancer (UBC) and whether patients thereby could omit cystoscopy. Methods All patients evaluated for macroscopic hematuria with CTU with cortico-medullary phase (CMP) and cystoscopy at our institute between 1st November 2016 and 31st December 2019 were included. From this study cohort a study group consisting of all UBC patients and a control group of 113 patients randomly selected from all patients in the study cohort without UBC. Two radiologists blinded to all clinical data reviewed the CTUs independently. CTUs were categorized as positive, negative or indeterminate. Diagnostic accuracy and proportion of potential omittable cystoscopies were calculated for the study cohort by generalizing the results from the study group. Results The study cohort consisted of 2195 patients, 297 of which were in the study group (UBC group, n = 207 and control group, n = 90). Inter-rater reliability was high (κ 0.84). Evaluation of CTUs showed that 174 patients were assesessed as positive (showing UBC), 46 patients as indeterminate (not showing UBC but with limited quality of CTU), and 77 patients as negative (not showing UBC with good quality of CTU). False negative rate was 0.07 (95%, CI 0.04–0.12), false positive rate was 0.01 (95% CI 0.0–0.07) and negative predictive value was 0.99 (95% CI 0.92–1.0). The area under the curve was 0.93 (95% CI 0.90–0.96). Only 2.9% (3/102) with high-risk tumors and 11% (12/105) with low- or intermediate-risk tumors had a false negative CTU. Cystoscopy could potentially have been omitted in 57% (1260/2195) of all evaluations. Conclusions CTU with CMP can exclude UBC with high accuracy. In case of negative CTU, it might be reasonable to omit cystoscopy, but future confirmative studies with possibly refined technique are needed.

A 55-year-old male patient came with complaint of painless haematuria for a duration of two months, and pain during micturition since two months. He was a chronic smoker for 20 years. The patient had no past history of tuberculosis. There was no history of fever. The patient did not receive any prior treatment. He was not on any medication for his present complaints. The patient was then advised Computed Tomography (CT) urography for further evaluation. There were multiple, well-defined endophytic lesions seen arising from the urinary bladder wall. These lesions were irregular in shape with papillary configuration [Table/Fig-1]. The CT urography features include, multiple well-defined, irregular papillary endophytic lesions arising from urinary bladder wall. Few areas of calcifications were noted within the lesions [Table/Fig-2]. On postcontrast study, the lesions showed moderate heterogeneous enhancement [Table/Fig-3]. Contrast was seen filling the interstices between papillary projections [Table/Fig-4]. All these features, point towards the malignancy involving the urinary bladder. Biopsy of one of the lesions was done which showed small hyperchromatic, pleomorphic transitional cells with poor differentiation invading the smooth muscle of the bladder wall. These findings confirmed the lesions as the transitional cell carcinoma of urinary bladder [Table/Fig-5]. Radical cystectomy was performed, followed by six cycles of chemotherapy. Bladder Cancer (BCA) is the 9th most common cancer, accounting for 3.9% of all cancer cases [1]. Males are three to four times more likely to develop urinary bladder cancer. Patients with urinary bladder cancer most frequently present with haematuria (90% of patients) that is typically painless [2]. Haematuria is the most common presentation. Dysuria, frequency of urination, nocturia, abdominal pain in advanced cases are few other symptoms [3]. The significant risk factors, for bladder cancer include smoking, arsenic exposure, chronic renal and bladder calculi, chronic urinary tract infections, schistosomiasis and family history of bladder cancer [3]. The CT urography has a sensitivity and specificity of greater than 90%, in patients with painless haematuria for the detection of urinary bladder cancer [4]. Multicentric urinary bladder cancers develop in 30-40% of cases and are more usually encountered in the presence of numerous endophytic lesions in the urinary bladder [5,6]. The other differential diagnosis is lymphoma or cystitis. Although primary urinary bladder lymphoma is uncommon, due to the absence of lymphoid tissue in urinary bladder, secondary bladder involvement may occur in upto 25% of people with lymphoma and leukaemia [7]. It is more common in adult women with vague urinary symptoms, haematuria, or a tumour. Lymphomas are well-defined bladder masses on imaging, rather than diffuse infiltration [7]. The tumours could be mistaken for urothelial cancer. Therefore, radiological imaging has an important role in the diagnosis of the malignancies involving the urinary bladder and directing appropriate management [8]. CT urography is an important tool in diagnosing the multifocal carcinoma of the urinary bladder with sensitivity and specificity of over 90%. It helps in appropriate management of the malignancy involving urinary bladder.

Although tuberculosis most commonly causes thickening and contracture of the urinary bladder, rarely, inflammatory infiltration with central necrosis and perforation may occur. Hereby, the authors present a case report of a 24-year-old man with recurrent spontaneous perforation of the urinary bladder due to tuberculosis. In the first presentation, he recovered well with conservative treatment. In the second presentation, he underwent ileal augmentation cystoplasty, and he did well after the definitive surgery. To the best of authors' knowledge, this is the first report of recurrent perforation of tuberculous urinary bladder. Perforation of the urinary bladder due to tuberculosis is a rarity, and a high index of clinical suspicion and appropriate investigation is needed for timely diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Purpose: To compare the utility of a novel metal artifact reduction algorithm to standard imaging in improving visualization of key structures, diagnostic confidence, and patient-level confidence in malignancy in patients with suspected bladder cancer. Methods: Patients with hip implants undergoing CT urography for suspected bladder malignancy were enrolled. Images were reconstructed using 3 methods: (1) Filtered Back Projection (FBP), (2) Iterative Metal Artifact Reduction (iMAR), and (3) Adaptive Iterative Metal Artifact Reduction (AiMAR) strength 4. In multiple reading sessions, three radiologists graded visualization of critical anatomic structures and artifact severity (6-point scales, lower scores desirable), and diagnostic confidence in blinded fashion. They also graded patient-level confidence in malignancy based on imaging findings in each patient. Results: Thirty-two patients (8 females) with a mean age of 74.5 ± 8.5 years were included. The median (range) visualization scores for FBP, iMAR, and AiMAR were 3.6 (1.1–4.9), 1.6 (0.3–2.8), and 1.6 (0.3–2.6), respectively. Both iMAR and AiMAR had anatomic visualization and artifact scores better than FBP (P < 0.001 for both) and similar to each other (P > 0.05). Structures with the most improvement in visualization score with the use of metal artifact reduction algorithms included the obturator internus muscle, internal and external iliac nodal chains, and vagina. iMAR and AiMAR improved diagnostic confidence (P < 0.001) and patient-level confidence in malignancy (P ≤ 0.24). Conclusion: For patients with hip prostheses and suspected bladder malignancy, the use of iMAR or AiMAR was shown to significantly reduce metal artifacts, thus improving diagnostic confidence and patient-level confidence in malignancy. [ABSTRACT FROM AUTHOR]

Vesicoureteral reflux (VUR) has been linked to recurrent urinary tract infections (UTIs), renal scarring, hypertension, renal insufficiency and end-stage kidney disease. Different imaging strategies have been proposed to approach children presenting with UTI to sort out patients with significant VUR while minimizing patient morbidity, radiation exposure and financial burden. None of these imaging strategies is universally accepted. The"top-down approach" (TDA) aims at restricting the number of voiding cystourethrograms (VCUGs) and its associated morbidity while identifying patients with clinically-significant reflux. In this approach, children presenting with febrile UTIs are acutely investigated with dimercapto-succinic acid (DMSA) renal scans to identify patients with renal parenchymal inflammation. Those with evidence of renal affection are offered VCUG and late DMSA scan to identify VUR and permanent renal scarring, respectively. Although TDA could identify clinically-significant VUR with high sensitivity, it is not without limitations. The approach segregates patients based on the presence of DMSA cortical lesions omitting the morbidity and the economic burden of UTI. Additionally, some of DMSA lesions are attributed to congenital dysplasia and unrelated to UTI. Ionizing radiation exposure, financial costs, limited availability of DMSA scans in the acute setting, variability in interpreting the results and low yield of actionable findings on DMSA scans are some other limitations. In this review, we tried to address the drawbacks of the TDA and reinforce the value of patient-centered approach for VUR.

Background: To evaluate the diagnostic accuracy of computed tomography-urography (CTU) to rule out urinary bladder cancer (UBC) and whether patients thereby could omit cystoscopy.Methods: All patients evaluated for macroscopic hematuria with CTU with cortico-medullary phase (CMP) and cystoscopy at our institute between 1st November 2016 and 31st December 2019 were included. From this study cohort a study group consisting of all UBC patients and a control group of 113 patients randomly selected from all patients in the study cohort without UBC. Two radiologists blinded to all clinical data reviewed the CTUs independently. CTUs were categorized as positive, negative or indeterminate. Diagnostic accuracy and proportion of potential omittable cystoscopies were calculated for the study cohort by generalizing the results from the study group.Results: The study cohort consisted of 2195 patients, 297 of which were in the study group (UBC group, n = 207 and control group, n = 90). Inter-rater reliability was high (κ 0.84). Evaluation of CTUs showed that 174 patients were assesessed as positive (showing UBC), 46 patients as indeterminate (not showing UBC but with limited quality of CTU), and 77 patients as negative (not showing UBC with good quality of CTU). False negative rate was 0.07 (95%, CI 0.04-0.12), false positive rate was 0.01 (95% CI 0.0-0.07) and negative predictive value was 0.99 (95% CI 0.92-1.0). The area under the curve was 0.93 (95% CI 0.90-0.96). Only 2.9% (3/102) with high-risk tumors and 11% (12/105) with low- or intermediate-risk tumors had a false negative CTU. Cystoscopy could potentially have been omitted in 57% (1260/2195) of all evaluations.Conclusions: CTU with CMP can exclude UBC with high accuracy. In case of negative CTU, it might be reasonable to omit cystoscopy, but future confirmative studies with possibly refined technique are needed. [ABSTRACT FROM AUTHOR]

Purpose: American Urological Association Urotrauma guidelines recommend delayed-phase imaging on presentation for all renal injuries, although data to support it are anecdotal. Forgoing delays risks unrecognized collecting system injuries. We hypothesized that renal trauma patients without admission delays have more complications from urinary extravasation. Materials and Methods: From 2005 through 2020, 1,751 renal trauma patients were identified from our institutional trauma registry. Included patients had an estimated American Association for the Surgery of Trauma renal injury grade of IIIeV and a perinephric fluid collection. Propensity scores for receipt of delayedphase imaging were calculated based on Injury Severity Score, arrival condition, admission systolic blood pressure, sex and renal injury grade. Propensity scoreadjusted logistic regression was used to compare clinical outcomes between those with and without admission delays. Results: Ninety (28.6%) of 315 included patients had delays on presentation. Patients without delays had higher Injury Severity Scores (29 vs 23, p[0.002), fewer isolated renal injuries (27.6% vs 38.9%, p[0.05) and lower grade renal injuries (56.9% vs 41.1% grade 3, p[0.03). After propensity score adjustment, patients with delays were more likely to undergo immediate interventions (OR 11.75, 95% CI 2.99e78.10) and interval stent placement for urinary extravasation (OR 6.86, 95% CI 1.56e47.64) without a difference in urological complications (OR 5.07, 95% CI 0.25e766.16). Conclusions: Delayed-phase imaging was associated with an increased odds of undergoing immediate and asymptomatic interval urological interventions without a difference in the odds of a complication after high-grade renal trauma. Post-trauma urinary extravasation requires further research to determine which patients require imaging and intervention. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose: To investigate the association between preoperative retrograde pyelography (RGP), conducted to evaluate upper tract urothelial carcinoma (UTUC), and intravesical recurrence (IVR) after radical nephroureterectomy (RNU). Materials and Methods: Of 114 patients that underwent RNU, 72 patients without preoperative ureteroscopy and a history of bladder tumor were selectively enrolled. Variables associated with IVR were identified. Results: RGP was performed at a mean duration of 24.9 days prior to RNU in 41 (56.1%) of study subjects. During the mean follow-up period of 64.5 months, IVRs were identified in 32 (44.4%) patients at 22.3±18.8 (mean±SD) months after RNU. Despite similar tumor characteristics in the RGP and non-RGP groups, the incidence of IVR was considerably higher in the RGP group (63.4%) than in the non-RGP group (19.4%, p pT2; 53.1% vs. 17.5%), preoperative hemoglobin (12.8±1.36 vs. 13.9±1.65), preoperative creatinine (1.29±0.32 vs. 1.11±0.22), and preoperative RGP (81.3% vs. 37.5%), respectively. Multivariate Cox regression model showed that tumor location (p=0.020, HR=2.742), preoperative creatinine level (p=0.004, HR=6.351), and preoperative RGP (p=0.045, HR=3.134) independently predicted IVR. Conclusion: Given the limitations of retrospective single-center series, performance of RGP before RNU was shown to have a negative effect on IVR after surgery.

Objectives To describe the feasibility and safety of ultrasound-guided percutaneous antegrade pyelography (US-PAP) in pet guinea pigs (Cavia porcellus) with suspected ureteral obstruction. Materials and methods Six adult pet guinea pigs (4 females and 2 males, all intact) were evaluated for suspected ureteral obstruction. The mean weight of the guinea pigs was 0.8 ± 0.25 kg (range 0.4–1.1 kg), and mean age was 4.07 ± 1.63 years (range 2–7 years). All animals were free from comorbid diseases, had clinical signs of urologic disease and were referred based on either strong clinical suspicion of, or diagnostic imaging of ureteral obstruction. Data on signalment and clinical examination findings, response to anaesthesia and imaging findings were recorded. Results Partial ureteral obstruction was confirmed in all guinea pigs but one, in which a complete ureteral obstruction occurred. Uroliths were in both ureters of 5 cases and in both the left renal pelvis and ureters in 1 case. All guinea pigs showed a normal appetite and regular defaecation within 2 h following the procedure. No intraoperative or immediate postoperative complications were encountered after the procedure. The only complication was contrast medium leakages in the subcapsular perinephric, retroperitoneal and, in one case, peritoneal space, which caused no overt clinical consequences afterwards. In one male patient, mobilisation of the ureteral calculus occurred and the urolith was found in the urinary bladder on the radiograph taken after contrast medium injection. Clinical significance The US-PAP technique is a useful, safe and easy-to-perform diagnostic tool in guinea pigs with hydronephrosis and hydroureter.

Hematuria may suggest bladder cancer, renal cell carcinoma, UUT-UCC, or urinary tract stones. Therefore, it is of interest to use Multi-Detector Computed Tomography (MDCT) to determine the cause of hematuria in children and connect MDCT results with cystoscopic and histological findings. The study included 110 young people under 40 with microscopic or macroscopic hematuria. A clinical exam and complete history were recorded. MDCT data from non-contrast and contrast-enhanced scans were properly documented. Histopathological and cystoscopic findings were noted alongside MDCT data when appropriate. The study's typical patient was 26 years old, 66% male. Eighty of the cases had hematuria as the cause. In 66 of 80 individuals, renal or ureteric calculi were the most common clinically relevant outcomes. There were four renal and four UB masses. Two cases of renal papillary necrosis and four of pyelonephritis/renal abscess were identified. MDCT diagnosed renal and vesical masses 100% accurately. MDCT can diagnose and treat hematuria, especially in young men, according to one study. The findings emphasize clinical awareness and targeted diagnosis. Further research is needed to determine hematuria causes and prevention across demographics., (© 2024 Biomedical Informatics.)

Background and objective Bladder cancer (BC) is a common urothelial neoplasm, with non-muscle invasive forms comprising about 75% of cases and generally having better outcomes than muscle-invasive types. Accurate preoperative grading and staging of BC are essential for appropriate treatment planning. This study investigates the efficacy of computerized tomography (CT) in correlating the morphological features of tumors to predict the histopathological grades of BC.  Materials and methods This retrospective cohort involved 100 patients diagnosed with non-muscle invasive BC, who underwent transurethral resection of bladder tumor (TUR-BT) between January 2010 and August 2021. CT imaging, utilizing a 128-slice CT scanner, was employed to measure the tumor height (H) and contact length (CL). The study considered morphometric parameters across axial, coronal, and sagittal planes. Statistical analyses were conducted, comparing radiological findings with histopathological evaluations. Tumor grading was determined according to the 2004/2016 WHO classification. Results Among the 100 patients with primary bladder tumors, 15 were female and 85 were male, with a mean age of 65.28 ± 7.11 years. Furthermore, 58 had high-grade bladder tumors, while 42 had low-grade bladder tumors. Across all planes, high-grade tumors exhibited higher values for the tumor H, CL, and the tumor height-to-contact length (H/CL) ratio compared to low-grade tumors (p<0.05). Notably, the specificity, sensitivity, and diagnostic accuracy of the tumor CL were higher than those of the tumor H and the tumor H/CL ratio. A tumor CL exceeding 19.1mm measured in the axial plane demonstrated 83% sensitivity and specificity for high-grade tumors. Conclusion The measured CL of the tumor in the axial plane on computerized tomography urography has high sensitivity and specificity in detecting high-grade tumors., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Health Sciences University, Istanbul Health Practice and Research Center Clinical Research and Ethics Committee issued approval Decision No: 2901, dated 13.08.2021. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Eroglu et al.)

ObjectiveTo evaluate the prevalence of incidental findings on preoperative abdominal computed tomography angiography-computed tomography urography in asymptomatic prospective renal donors.MethodsA Health Insurance Portability and Accountability Act (HIPAA)-compliant, Institutional Review Board (IRB)-approved retrospective study of 1,597 subjects undergoing renal transplant evaluation from June 1, 2006, to March 31, 2011, was performed. Candidates underwent multiphasic multidetector computed tomography angiography-computed tomography urography for presurgical evaluation of renal vascular and parenchymal anatomy. All scans were reviewed by one of three fellowship-trained abdominal radiologists. The diagnoses were made on the basis of computed tomography characteristics of each lesion, and pathology confirmation was available for seven patients. We calculated the prevalence of each incidental finding, performed Fisher exact test or chi-square test for categorical variables between the cohort that did and did not undergo donor nephrectomy, and performed simple linear logistic regression analysis of incidental findings which predicted renal donation.ResultsOf the 1,597 potential donors, 58.4% were female, and the mean age was 42.6 years (range, 18-74). One thousand one hundred ninety-five (74.9%) had a total of 2,105 incidental findings. Based on American College of Radiology Incidental Findings Committee White Paper on Managing Incidental Findings on Abdominal Computed Tomography, 17.3% had incidentalomas and 1.1% required follow-up. Majority of the incidental findings (16 of 17) were in patients who did not undergo renal donation. The prevalence of pathologically proven malignancy was 0.1% (3 of 1,597).ConclusionPreoperative computed tomography angiography-computed tomography urography not only identifies vascular anatomy but may also help detect clinically significant unanticipated findings in an otherwise healthy population.

Abstract Background Our aim was to compare CT images from native, nephrographic and excretory phases using image quality criteria as well as the detection of positive pathological findings in CT Urography, to explore if the radiation burden to the younger group of patients or patients with negative outcomes can be reduced. Methods This is a retrospective study of 40 patients who underwent a CT Urography examination on a 192-slice dual source scanner. Image quality was assessed for four specific renal image criteria from the European guidelines, together with pathological assessment in three categories: renal, other abdominal, and incidental findings without clinical significance. Each phase was assessed individually by three radiologists with varying experience using a graded scale. Certainty scores were derived based on the graded assessments. Statistical analysis was performed using visual grading regression (VGR). The limit for significance was set at p = 0.05. Results For visual reproduction of the renal parenchyma and renal arteries, the image quality was judged better for the nephrogram phase (p

Ureteric entrapment within the sacroiliac joint (SIJ) is very rare. However, we experienced a case of a 77-year-old woman who presented with right hydronephrosis during a routine health check. Computed tomography and retrograde pyelography showed entrapment of the right ureter at the level of the SIJ, with a right proximal hydroureter, which was confirmed during surgery. Herein, we described this case and present a review of the literature on similar cases.

Purpose: Multidetector computed tomographic urography (MDCTU) is not yet sufficient to be used in the clinical staging of upper tract urothelial carcinoma (UTUC). This study aimed to compare the diagnostic accuracy of MDCTU T stage classification and pathologic T staging for UTUC. Methods: We retrospectively evaluated 125 patients with UTUC who underwent preoperative MDCTU. A single radiologist classified the MDCTU pattern of the tumors as either low or advanced T stage for localized or locally advanced tumors, respectively. The diagnostic values of MDCTU for locally advanced tumors and the kappa agreement between MDCTU and pathologic T stage were investigated. Results: Among 85 pathologic low T stage (Ta–T2) tumors, 71 low T stage tumors were correctly detected by MDCTU, while 30 out of 40 advanced T stage (T3–T4) tumors were correctly diagnosed by MDCTU. MDCTU led to under-staging in 8% (10/125) tumors and over-staging in 11.2% (14/125) tumors. Therefore, the overall accuracy of MDCTU in the diagnosis of low and advanced T stage tumors was 80.8% (101/125 patients). The sensitivity for advanced T stage tumors was 75% (30/40), the specificity was 83.5% (71/85), and the positive and negative predictive values were 68.1% (30/44) and 87.6% (71/81), respectively. The kappa agreement value between the MDCTU T stage and pathologic T stage was 0.57 (95% confidence interval (CI) 0.42–0.72), which was statistically significant (P = 0.001). Conclusion: MDCTU T stage classification may be relatively accurate for the detection and staging of UTUC correspondence with a pathologic stage. [ABSTRACT FROM AUTHOR]

Background: Functional magnetic resonance urography (MRU) is well established in the diagnostic workup of urinary tract anomalies in children, providing comprehensive morphological and functional information. However, dynamic contrast-enhanced images acquired in the standard Cartesian k-space manner are prone to motion artifacts. A newly introduced 4D high spatiotemporal resolution dynamic contrast-enhanced magnetic resonance imaging based on variable density elliptical centric radial stack-of-stars sharing technique has shown improved image quality regarding motions under free breathing., Objective: The aims of this study were to implement this 4D free-breathing sequence for functional MRU and to compare its image quality and analyzability with standard breath-hold Cartesian MRU., Materials and Methods: We retrospectively evaluated all functional 4D MRU performed without general anesthesia between September 2021 and December 2022 and compared them with matched pairs (age, affected kidney, diagnosis) of standard Cartesian MRU between 2016 and 2022. Image analysis was performed by 2 radiologists independently regarding the following criteria using a 4-point Likert scale, with 4 being the best: overall image quality, diagnostic confidence, respiratory motion artifacts, as well as sharpness and contrast of aorta, kidneys, and ureters. We also measured vertical kidney motion due to respiratory motion and compared the variance for each kidney using F test. Finally, both radiologists calculated the volume, split renal volume (vDRF), split renal Patlak function (pDRF), and split renal function considering the volume and Patlak function (vpDRF) for each kidney. Values were compared using Bland-Altman plots and F test., Results: Forty children (20 for 4D free-breathing and standard breath-hold, respectively) were enrolled. Ten children of each group were examined using feed-and-sleep technique (median age: 4D, 3.3 months; standard, 4.2 months), 10 were awake (median age: 4D, 8.9 years; standard, 8.6 years). Overall image quality, diagnostic confidence, respiratory motion artifacts, as well as sharpness and contrast of the aorta, kidneys, and ureters were rated significantly better for 4D free-breathing compared with standard breath-hold by both readers ( P ranging from <0.0001 to 0.005). Vertical kidney motion was significantly reduced in 4D free-breathing for the right and the left kidney (both P < 0.001). There was a significantly smaller variance concerning the differences between the 2 readers for vpDRF in 4D MRU ( P = 0.0003). In contrast, no significant difference could be demonstrated for volume ( P = 0.05), vDRF ( P = 0.93), and pDRF ( P = 0.14)., Conclusions: We demonstrated the feasibility of applying a 4D free-breathing variable density stack-of-stars imaging for functional MRU in young pediatric patients with improved image quality, fewer motion artifacts, and improved functional analyzability., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Teaching point: A fibroepithelial polyp is an intraluminal, long, slender neoplasm that frequently occurs in the ureteropelvic junction and upper ureter.

Purpose: To prospectively assess the diagnostic potential of computed tomography urography (CTU) as a prior examination in the detection of bladder cancer. Materials and Methods: A total of 3280 CTU examinations were assessed in 3050 consecutive patients. Patients who were over 35 years of age, with gross hematuria, persistent microhematuria, or a history of urothelial tumor, were included in our study. Our study investigated the diagnostic capability of CTU over the course of two prior examinations. After the first examination, patients with a definite lesion observed by CTU were referred directly for rigid cystoscopy (RC) and patients with negative or probable lesion were referred for flexible cystoscopy (FC). After the second examination, patients with a definite lesion observed by CTU were referred directly for RC, patients with probable lesion were referred for FC, and patients with negative lesion were referred for clinical follow-up. Performance characteristics for the two prior examinations were determined by using pathologic findings or clinical follow-up as the reference standard. Results: The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for detecting bladder cancer were 95.2%, 95.4%, 95.4%, 69.1%, and 99.2%, respectively, for the first prior examination, and 93.4%, 93.3%, 93.3%, 61.1%, and 98.4%, respectively, for the second prior examination. Conclusion: CTU as a prior examination is accurate for the early detection of bladder cancer. Notably, when used as a second prior examination, CTU could help to avoid the unnecessary use of FC in patients with negative lesions.

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Background: Computed tomography urography (CTU), based on the excretion of contrast medium after its injection, allows visualization of the renal parenchyma and the renal collecting system. Objectives: To determine the optimal contrast medium dose allocation ratio to apply in splitbolus CTU in dogs. Methods: This prospective, experimental, exploratory study used 8 beagles. In 3-phase CTU, unenhanced-, nephrographic-, and excretory-phase images were obtained with a single injection of 600 mg iodine/kg iohexol. In split-bolus CTU, two different contrast medium allocation ratios (30% and 70% for split CTU 1; 50% and 50% for split CTU 2) were used. Unenhanced phase image and a synchronous nephrographic-excretory phase image were acquired. Results: Although the attenuation of the renal parenchyma was significantly lower when using both split CTUs than the 3-phase CTU, based on qualitative evaluation, the visualization score of the renal parenchyma of split CTU 1 was as high as that of the 3-phase CTU, whereas the split CTU 2 score was significantly lower than those of the two others. Artifacts were not apparent, regardless of CTU protocol. The diameter and opacification of the ureter in both split CTUs were not significantly different from those using 3-phase CTU. Conclusions: Split-bolus CTU with a contrast medium allocation ratio of 30% and 70% is feasible for evaluating the urinary system and allows sufficient enhancement of the renal parenchyma and appropriate distention and opacification of the ureter, with similar image quality to 3-phase CTU in healthy dogs. Split-bolus CTU has the advantages of reducing radiation exposure and the number of CT images needed for interpretation. [ABSTRACT FROM AUTHOR]

Objectives: To develop technical guidelines for computed tomography urography.Methods: The French Society of Genitourinary Imaging organised a Delphi consensus conference with a two-round Delphi survey followed by a face-to-face meeting. Consensus was strictly defined using a priori criteria.Results: Forty-two expert uro-radiologists completed both survey rounds with no attrition between the rounds. Ninety-six (70%) of the initial 138 statements of the questionnaire achieved final consensus. An intravenous injection of 20 mg of furosemide before iodinated contrast medium injection was judged mandatory. Improving the quality of excretory phase imaging through oral or intravenous hydration of the patient or through the use of an abdominal compression device was not deemed necessary. The patient should be imaged in the supine position and placed in the prone position only at the radiologist's request. The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation. Repeated single-slice test acquisitions should not be performed to decide of the timing of excretory phase imaging; instead, excretory phase imaging should be performed 7 min after the injection of the contrast medium. The optimal combination of unenhanced, corticomedullary phase and nephrographic phase imaging depends on the context; suggestions of protocols are provided for eight different clinical situations.Conclusion: This expert-based consensus conference provides recommendations to standardise the imaging protocol for computed tomography urography.Key Points: • To improve excretory phase imaging, an intravenous injection of furosemide should be performed before the injection of iodinated contrast medium. • Systematic oral or intravenous hydration is not necessary to improve excretory phase imaging. • The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation. [ABSTRACT FROM AUTHOR]

Background: Three-phase CT urography (CTU) is the gold standard for evaluating the upper urinary tract in patients with hematuria. We aimed to evaluate the accuracy of CTU for detecting upper urothelial cell carcinomas (UCC) in patients with hematuria and negative cystoscopy. Secondly, we aimed to determine the tumor visibility on each CTU phase.Material and Methods: This retrospective study included all patients with hematuria referred to CTU after a negative cystoscopy during 2016 and 2017. The original CTU reports were dichotomized as negative or positive. All patient charts were reviewed after a minimum of 18-month follow-up in order to register missed cancers. The results of biopsies and clinical follow-up were used as the reference standard. Two reviewers retrospectively evaluated the tumor visibility of each CT sequence in all true-positive CTUs.Results: We included 376 patients with hematuria who underwent CTU after a negative cystoscopy. Macroscopic and microscopic hematuria occurred in 87% (327) and 13% (49), respectively. The incidence of upper urothelial cell carcinoma was 1.9% (7), and the sensitivity of CTU was 100% (95% CI, 59-100), specificity was 99% (95% CI, 98-100), positive predictive value was 88% (95% CI, 47-99), and negative predictive value was 100% (95% CI, 99-100). The accuracy was 99% (95% CI, 90-100). All UCCs were visible on the nephrographic phase for both reviewers.Conclusion: CTU is highly accurate for detecting upper UCCs. All cases were seen on the nephrographic phase. This suggests that the CTU protocol can be simplified.Key Points: • CT urography is highly accurate for detecting upper urothelial cell carcinomas. • All cancers were seen on the nephrographic phase. • All cancers were detected in patients with macroscopic hematuria. [ABSTRACT FROM AUTHOR]

Aim: Dilatation of the urinary tract is an important sign in the diagnosis of its obstruction. Unfortunately, there is a significant inter-individual variability in the size of the renal pelvis and ureter, furthermore, their size is influenced by other factors, e.g. hydration status. The aim of the work was to evaluate the effect of hydration on urinary tract diameters. Methods: Totally 110 patients (77 men, 33 women, average age 65 years) with bilateral normal finding on the both kidneys met the inclusion criteria. The CT protocol included an unenhanced, corticomedular, nephrographic, and excretory phase. During the examination, 70 ml of contrast agent and 30 ml of saline were injected, followed by an intravenous infusion of 120 ml saline to promote diuresis. We measured the intra-renal and extra-renal anteroposterior diameter (APD) of the pelvis and the width of the abdominal ureter in an unenhanced phase (low hydration status) and in an excretory phase (high hydration status). We statistically compared the dimensions in the unenhanced and excretory phases and then we compared the values between the right and left side. Results: The difference in intra- and extrarenal APD and abdominal ureter width in unenhanced and excretory phases was statistically significant on both sides: intra-renal APD on the right - median 5.55 mm (range 2-15.5 mm) vs. median 7.5 mm (range 2.7-17.2 mm); extrarenal APD on the right - median 7 mm (range 2-24.4 mm) vs. 9.15 mm (range 1.8-25.3 mm); intra-renal APD on the left -- median 5.45 mm (range 1.6-16.7 mm) vs. median 6.6 mm (range 1.8-25.3 mm); extra-renal APD on the left -- median 7.15 mm (range 1.7-18.6 mm) vs. median 8.55 mm (range 1.8-25.8 mm); the width of ureter on the right -- median 3.83 mm (range 1.8-9.4 mm) vs. median 4.25 mm (range 2.05-9.25 mm); the width of ureter on the left -- median 3.9 mm (range 1.55--7.9 mm) vs. 4.23 mm (range 1.55-9.65 mm), all comparisons on the significance level p < 0.001. Comparison of diameters between the left and right side revealed mean differences less than 0.8 mm in renal pelvis dimensions and less than 0.3 mm in ureters. Conclusion: The diameters of the adult renal pelvis and ureter revealed great interindividual variability and significant influence of hydration status. Lateral symmetry seems to be more reliable tool for the diagnosis of urinary tract obstruction, than urinary tract dimensions measurement. [ABSTRACT FROM AUTHOR]

Introduction: Trauma to the genitourinary system includes blunt and penetrating injuries to bladder and ureters. These are rare injuries and are overlooked as other abdominal and pelvic injuries often take priority. Delayed diagnosis can lead to significant morbidity and mortality. Computed tomography has taken a central role in the imaging of the ureters and bladder. Methods: This article reviews the anatomic relationships, mechanisms of injury, and clinical presentation to help physicians determine when bladder and ureteral injuries should be suspected and further imaging should be pursued. Radiologic evaluation of bladder and ureteral injury with CT cystography and CT urography, respectively, will be reviewed. Conclusion: CT cystography and CT urography are effective tools in identifying potentially serious injuries to the genitourinary system. Timely recognition of these injuries can be crucial for the overall management and prognosis. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging of the upper tract (pyelocalyces and ureters) or MR Urography (MRU) is technically possible and when performed correctly offers similar visualization of the upper tracts and for detection of non-calculous diseases of the collecting system similar specificity but with lower sensitivity compared to CTU. MRU provides the ability to simultaneously image the kidneys and urinary bladder with improved soft tissue resolution, better tissue characterization and when combined with assessment of the upper tract, a comprehensive examination of the urinary system. MRU requires meticulous attention to technical details and is a longer more demanding examination compared to CTU. Advances in MR imaging techniques including: parallel imaging, free-breathing motion compensation techniques and compressed sensing can dramatically shorten examination times and improve image quality and patient tolerance for the exam. This review article discusses updates in the MRU technique, summarizes clinical indications and opportunities for MRU in clinical practice and reviews advantages and disadvantages of MRU compared to CTU. [ABSTRACT FROM AUTHOR]