This Article Figures Only Full Text Full Text (PDF) Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Richenberg, J Search for Related Content PubMed Articles by Richenberg, J

Haematuria

Department of Imaging, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK

• Haematuria is a common problem in primary and secondary care, justifiably consuming a large amount of clinical time and imaging resources, not least because it may be the sole manifestation of malignancy of the urinary tract.
  
• Imaging is central in identifying this very subgroup (those with malignant lesions) and also those with urolithiasis; pathways in secondary care aim to integrate imaging and clinical assessment to provide a one-stop service.
  
• Ultrasound and CT provide most of the useful information, with CT urography (CTU) all but replacing intravenous urography (IVU).
  
• Debate has raged about the optimal first- and second-line investigations for haematuria, with the majority now advocating ultrasound and plain radiographs as suitable without the need for IVU in the initial work-up; the imaging strategies proposed are, however, bound to evolve as CTU and CT colic supplant IVU.
  
• Regardless of the preferred local imaging pathway for haematuria, optimizing each technique, paying close detail to issues of patient preparation and dose, will ensure that imaging continues to be at the forefront of lesion detection, evaluation and staging in patients with haematuria.
  

Haematuria can be microscopic or visible to the naked eye (macroscopic): both forms may be the sole manifestation of serious pathology. Clinicians must rationalize investigations to ensure that bleeding due to renal tract tumours, urolithiasis or infections is diagnosed and treated promptly; yet they must also avoid increasing morbidity, anxiety and cost by over-investigating low-risk patients. This article considers a number of strategies to achieve this balance, weighing up the merits of different techniques as first- and second-line tests in investigating haematuria. First, I discuss the detection of haematuria, concentrating in particular on the roles of dipstick testing and microscopy. My emphasis then moves to comparing the relevant radiological investigations. I include an extended section on CT urography, reflecting the increasing utility of this technique in urological practice. Each imaging modality is considered within a broader clinical context, and the protocol put forward for investigating haematuria is related to other published protocols. Various key pathologies are introduced and addressed throughout the review, and the final section summarizes specific conditions and imaging findings.