Evaluating Upper Tract Urothelial Malignancies with Computed Tomography Urography in Hematuria Patients: A Retrospective Study
Abstract:
Objective: To assess the age-stratified prevalence of upper tract urothelial malignancies identified through computed tomography urography in a large cohort of patients referred for the initial evaluation of hematuria. Materials and Methods: A total of 961 consecutive adults, all without a prior history of urothelial cancer, underwent initial computed tomography urography for gross hematuria (n = 563), microscopic hematuria (n = 839), or unspecified hematuria (n = 9) at a single institution, the urology department of CHU Casablanca, between February 2020 and February 2024. Imaging findings indicative of urothelial lesions were cross-referenced with clinical data, including cystoscopy, cytology, and surgical pathology reports. Patients who were later diagnosed with urothelial cancer despite a normal initial radiographic evaluation were identified and analyzed. Factors such as age, gender, smoking history, as well as the location and type of malignancy, were examined. Results: Upper tract urothelial cancer was diagnosed in 5 patients (0.48%), with a mean age of 68.4 years. All 5 patients were presented with gross hematuria and had a history of smoking, either current or former. One case involved a patient under the age of 50 who was diagnosed with upper tract urothelial cancer following computed tomography urography. Additionally, no cases of upper tract cancer were identified in patients referred for microscopic hematuria, regardless of their age. Conclusion: Detection of upper tract urothelial cancer through computed tomography urography is extremely uncommon in patients with hematuria, especially in those categorized as lower risk (e.g., younger age, microscopic hematuria) at tertiary referral centers. Further research into risk-stratified imaging strategies for hematuria workup is essential to reduce unnecessary costs and radiation exposure.
