30 days before the first PCN were analyzed in terms of findings and recommendation (including percutaneous, endourologic, and open surgical procedures). The identified etiologies were categorized and subcategorized. Comparisons of recommendation rate among categories were performed using chi-square (po0.05 statistically significant). Results: 260 cases of unilateral UTO undergoing at least one attempt of PCN had diagnostic imaging prior to the procedure. 9 cases (3.46%) were recommended for operation in radiologists' report, including 1 case of unknown etiology and 8 cases of neoplasm (3 advanced cervical cancer/uterine mass, 2 prostate cancer, 2 advanced colon cancer, and 1 retroperitoneal mass). In contrast, 251 cases (96.54%) had no recommendation on the management in which the neoplasm was the most common etiology and 2). There is relatively high recommendation rate in neoplasm group, although there is no significant difference in recommendation rate among all categories (p¼0.56). Similarly, there is no significant difference in the recommendation rate among the subcategories of neoplasms (p¼0.06). This comparison implies a low recommendation rate that is not associated with any etiology. The higher incidence of malignant UTO does not make radiologists be more aware of the necessity of decompressing urinary tract. Conclusions: Only a small proportion (3.46%) of UTO was appropriately recommended for operation, indicating low compliance with ACR Appropriateness Criteria in light of managing UTO.

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