Performance of computed tomographic urography for the detection of bladder tumors in patients with microscopic hematuria

Aguilar-Davidov, Bernardo; Ramírez-Muciño, A.; Culebro-García, Carolina; Sotomayor, Mariano; Castillejos-Molina, R.A.; Feria-Bernal, Guillermo; Rodríguez-Covarrubias, Francisco

doi:10.1016/j.acuroe.2012.09.004

Cited by 2 publications

(3 citation statements)

References 16 publications

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“…4 Citing the low incidence of malignancies for patients with low-to intermediate-risk microscopic hematuria, the risk of radiation exposure, and the high costs and low specificity of CTU, the AUA's 2020 guidelines now recommend ultrasound instead of CTU for patients with lowto intermediate-risk microscopic hematuria. 1,[5][6][7][8] Accordingly, continued use of CTU for these patients represents low-value care that should be deimplementeddie, discontinued due to lack of effectiveness or potential harm. 9 Rates of adherence to the AUA's revised microscopic hematuria guideline are currently unknown.…”

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confidence: 99%

Toward the Deimplementation of Computed Tomography Urogram for Patients With Low- to Intermediate-risk Microscopic Hematuria: A Mixed-method Study of Factors Influencing Continued Use

et al. 2023

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Introduction: Citing high costs, limited diagnostic benefit, and ionizing radiationeassociated risk from CT urogram, in 2020 the AUA revised its guidelines from recommending CT urogram for all patients with microscopic hematuria to a deintensified risk-stratified approach, including the deimplementation of low-value CT urogram (ie, not recommending CT urogram for patients with lowto intermediate-risk microscopic hematuria). Adherence to revised guidelines and reasons for continued low-value CT urogram are unknown.

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confidence: 99%

Toward the Deimplementation of Computed Tomography Urogram for Patients With Low- to Intermediate-risk Microscopic Hematuria: A Mixed-method Study of Factors Influencing Continued Use

et al. 2023

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“…Through full manuscript review, we excluded an additional 212 studies. Therefore, a total of 20 studies 2,4,5,21-37 met the inclusion criteria, 15 2,5,21-26,29,32-37 of which reported on diagnostic test characteristics of the imaging modalities, and 5 4,27,28,30,31 of which reported on outcomes identified as important to the AUA hematuria guideline, 3 such as cost, but out of scope for the current publication. Of the 15 studies reporting on diagnostic test characteristics, 6 2,21-25 were included in the final quantitative synthesis and 9 5,26,29,32-37 were not used in the meta-analysis or to calculate post-test probabilities as they did not include sufficient detail to calculate sensitivities, specificities, or likelihood ratios.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, a total of 20 studies 2,4,5,21-37 met the inclusion criteria, 15 2,5,21-26,29,32-37 of which reported on diagnostic test characteristics of the imaging modalities, and 5 4,27,28,30,31 of which reported on outcomes identified as important to the AUA hematuria guideline, 3 such as cost, but out of scope for the current publication. Of the 15 studies reporting on diagnostic test characteristics, 6 2,21-25 were included in the final quantitative synthesis and 9 5,26,29,32-37 were not used in the meta-analysis or to calculate post-test probabilities as they did not include sufficient detail to calculate sensitivities, specificities, or likelihood ratios. A summary of the risk of bias assessment for the 6 studies included within the quantitative analysis can be found in supplementary Appendix 2 (https://www.jurology.com) and GRADE profiles can be found in supplementary Appendix 3 (https://www.jurology.com).…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Imaging in the Evaluation of Asymptomatic Microhematuria: Systematic Review and Meta-analysis

Taylor

Souter²,

Barocas

et al. 2023

Journal of Urology

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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.

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Performance of computed tomographic urography for the detection of bladder tumors in patients with microscopic hematuria

Cited by 2 publications

References 16 publications

Toward the Deimplementation of Computed Tomography Urogram for Patients With Low- to Intermediate-risk Microscopic Hematuria: A Mixed-method Study of Factors Influencing Continued Use

Toward the Deimplementation of Computed Tomography Urogram for Patients With Low- to Intermediate-risk Microscopic Hematuria: A Mixed-method Study of Factors Influencing Continued Use

Diagnostic Imaging in the Evaluation of Asymptomatic Microhematuria: Systematic Review and Meta-analysis

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