Is Bladder Ultrasound Indicated as Part of the Routine Investigation of Haematuria?

Abstract

Many patients presenting with haematuria undergo intravenous urography, renal tract ultrasound and cystoscopy. Renal tract ultrasound includes imaging of the bladder, which can significantly increase scan times by necessitating bladder filling, which can impact negatively on appointment scheduling. Little published literature exists on whether ultrasound of the bladder in the presence of haematuria is of any clinical benefit. This study aims to redress this by comparing bladder ultrasound to the gold standard of cystoscopy and also by assessing temporal implications in this patient group. A prospective study was undertaken where 96 consecutive urology-referred patients had their bladder ultrasound findings compared with the findings of cystoscopy under the headings of mass, trabeculation, diverticulum, stone and fistula. Ultrasound had poor sensitivity (47.8%), but good specificity (94.5%) in detecting the predefined bladder pathologies with a poor Kappa score of 0.33 when compared with cystoscopy. In addition, there was a significant time burden placed on the list by including bladder scanning as part of the renal tract sonographic assessment. In conclusion, bladder ultrasound is not shown to be a clinically useful adjunct to cystoscopy for the detection of bladder pathology. We would recommend that, in the setting of haematuria, ultrasound be used only for upper tract assessment.