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CT Urography for Hematuria Evaluation

Comprehensive multiphase contrast-enhanced computed tomography examination of the urinary tract from kidneys to bladder including unenhanced, nephrographic, and excretory phases for evaluation of hematuria with high diagnostic accuracy for urolithiasis, urothelial malignancy, and renal masses.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Radyoloji department. Book Appointment →

What is CT Urography for Hematuria Evaluation?

CT urography (CTU) is a multiphase contrast-enhanced CT examination optimized for evaluation of the urinary tract including kidneys, ureters, and bladder. It has largely replaced intravenous urography (IVU) and ultrasound for hematuria workup.

Standard protocol includes: unenhanced phase (stones, hyperdense lesions), corticomedullary phase 25-40 sec (renal masses, vascular structures), nephrographic phase 90-100 sec (renal parenchyma, masses), and excretory/delayed phase 5-15 minutes (collecting system, ureters, bladder filling).

Indications: gross hematuria (>3 RBC/HPF in adults), microscopic hematuria with risk factors (smoking, age >35, occupational exposure), evaluation of urinary tract symptoms, post-treatment surveillance for urothelial cancer, suspected urinary tract obstruction or trauma.

Symptoms

Gross hematuria (visible blood in urine)
Microscopic hematuria (>3 RBCs/HPF) with risk factors
Flank pain suggestive of urolithiasis
Urinary tract obstruction symptoms
Recurrent urinary tract infections in adults
Suspected urothelial carcinoma
Hydronephrosis on prior imaging
Post-renal transplant evaluation

Risk Factors

Smoking (most important risk factor for urothelial cancer)
Male sex (3-4× higher urothelial cancer risk)
Age >35 years (increasing with age)
Occupational exposure (rubber, dye, chemicals, leather)
Chronic urinary tract infections or bladder stones
Pelvic radiation history
Cyclophosphamide treatment history
Family history of urinary tract malignancy

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Visible blood in urine without infection
  • Microscopic hematuria with risk factors per AUA guidelines
  • Flank pain with renal colic features
  • Recurrent UTI not responding to treatment in adults
  • Suspected obstructive uropathy
  • Post-treatment surveillance after urothelial cancer
  • Hydronephrosis discovered incidentally on other imaging
  • Trauma with suspected urinary tract injury

Treatment Methods

01
Patient preparation: hydration to ensure adequate ureteral distension, NPO 4-6 hours
02
Renal function assessment: serum creatinine and eGFR before iodinated contrast
03
Unenhanced phase: low-dose CT for stone detection and identification of hyperdense lesions
04
Iodinated contrast injection 100-150 mL at 3-4 mL/sec
05
Corticomedullary phase 25-40 sec: characterizes renal masses, vascular anatomy
06
Nephrographic phase 90-100 sec: renal parenchyma evaluation, optimal for mass detection
07
Excretory phase 5-15 min after contrast: collecting system, ureteral filling, bladder
08
Optional split-bolus technique combining nephrographic and excretory phases reducing radiation
09
Furosemide 0.1 mg/kg IV before contrast can improve ureteral distension
10
Comprehensive interpretation: stones, masses, urothelial lesions, anatomic variants, complications

Which Department to Visit?

You can visit our Radyoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.