The objective of this study was to determine the efficacy of ultrasonography and urography in evaluating patients presenting with painless gross haematuria for urinary malignancies. From October 1992 to March 1997, 468 consecutive patients presenting with painless gross haematuria were prospectively investigated. Ultrasonography and urography were performed independently, followed by diagnostic cystoscopy and other relevant investigations. One hundred and twenty-five urinary malignancies (26.7%) were detected in 122 patients, 85 being carcinoma of bladder (85/468 patients; 18.2%), followed by renal cell carcinoma (25/468 patients; 5.3%). Ultrasonography was significantly more sensitive (83/85; 98%) in the detection of bladder tumours, compared to urography (42/78; 54%) (P <0.05). In the upper tract, there was no significant difference in the sensitivity of lesion detection. Ultrasonography is more sensitive than urography for diagnosing urological malignancies in patients presenting with painless gross haematuria, where carcinoma of bladder is the commonest pathology. Its utilisation as an initial screening investigation is recommended. Patients diagnosed to be suffering from carcinoma of bladder by ultrasonography should be scheduled directly and promptly for therapeutic endoscopy.
Haematuria of any degree should never be ignored and, in adults, it should be regarded as a symptom of urological malignancy until proven otherwise. Mariani et al, in their evaluation of 1000 consecutive patients, revealed life-threatening lesions in 9.1% of cases.
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