Comparative Assessment of CT Urography and Ultrasound in Low-Risk vs. High-Risk Patients with Hematuria & their Management strategies

Abstract

Background: Hematuria requires accurate diagnostic evaluation to identify its underlying cause. Imaging modalities such as CT urography and ultrasound are routinely employed, but their comparative effectiveness in low-risk and high-risk patients remains underexplored.
Objective: This study aims to compare the diagnostic utility of CT urography and ultrasound in evaluating hematuria among low-risk and high-risk patients and to analyze management strategies, including surgical interventions.
Methods: A prospective study was conducted on 100 patients with hematuria, divided into low-risk and high-risk groups based on clinical criteria. All patients underwent CT urography and ultrasound. Management plans, including surgical interventions, were documented. Sensitivity, specificity, diagnostic accuracy, and detection rates for urothelial abnormalities, stones, and malignancies were compared between the two modalities.
Results: CT urography demonstrated higher sensitivity (92%) and specificity (89%) compared to ultrasound (78% sensitivity and 82% specificity) across all patient groups. In high-risk patients, CT urography detected 96% of malignancies, while ultrasound identified 80%. Surgical management varied between groups; high-risk patients underwent more extensive surgeries. CT urography outperformed ultrasound in identifying urothelial abnormalities and malignancies across both groups.
Conclusions: CT urography provides superior diagnostic accuracy, particularly in high-risk patients with suspected malignancies, influencing management decisions, including surgical interventions. Ultrasound remains a useful initial screening tool for low-risk patients due to its non-invasive nature and cost-effectiveness.