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Title: The development of CT urography for investigating haematuria
Author: Cowan, Nigel Christopher
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2013
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This thesis addresses the three principal questions concerning the development of CT urography for investigating haematuria and each question is the subject of a separate chapter. The questions are: What is the reasoning behind using CT urography? What is the optimum diagnostic strategy using CT urography? What are the problems with using CT urography and how may solutions be provided? Haematuria can signify serious disease such as urinary tract stones, renal cell cancer, upper tract urothelial cancer (UTUC) and bladder cancer (BCa). CT urography is defined as contrast enhanced CT examination of kidneys, ureters and bladder. The technique used here includes unenhanced, nephrographic and excretory-phases for optimized diagnosis of stones, renal masses and urothelial cancer respectively. The reasoning behind using excretory-phase CT urography for investigating haematuria is based on results showing its high diagnostic accuracy for UTUC and BCa. Patients with haematuria are classified as low risk or high risk for UTUC and BCa, by a risk score, determined by the presence/absence of risk factors: age > 50 years, visible or nonvisible haematuria, history of smoking and occupational exposure. The optimum diagnostic strategy for patients at high risk for urothelial cancer, uses CT urography as a replacement test for ultrasonography and intravenous urography and as a triage test for flexible and rigid cystoscopy, resulting in earlier diagnosis and potentially improving prognosis. For patients at low risk, ultrasonography, unenhanced and nephrographic-phase CT urography are proposed as initial imaging tests. Problems with using CT urography include false positive results for UTUC, which are eliminated by retrograde ureteropyelography-guided biopsy, an innovative technique, for histopathological confirmation of diagnosis. Recommendations for the NHS and possible future developments are discussed. CT urography, including excretory-phase imaging, is recommended as the initial diagnostic imaging test before cystoscopy for patients with haematuria at high risk for urothelial cancer.
Supervisor: Harris, Adrian Sponsor: Not available
Qualification Name: Thesis (D.M.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Computed tomography urography ; Haematuria ; Cancer ; Diagnosis ; Life Sciences ; Oncology ; Tumours ; Urology ; Medical Sciences ; biomarkers ; biopsy ; bladder cancer ; carcinoma ; renal cell ; transitional cell ; computed tomography ; x-ray ; cost effectiveness ; cost savings ; costs and cost analysis ; cystoscopy ; cytology ; diagnostic errors ; diagnostic imaging ; diagnostic techniques and procedures ; diagnostic techniques ; urological ; diagnostic tests ; disease-free survival ; early detection of cancer ; early diagnosis ; educational assessment ; educational techniques ; hematuria ; incidental findings ; kidney calculi ; kidney neoplasms ; neoplasm grading ; neoplasm staging ; prognosis ; pyelography ; retrograde ; risk factors ; sensitivity and specificity ; ultrasonography ; ureteral calculi ; ureteral catheterization ; urinary bladder calculi ; urinary bladder cancer ; urinary bladder neoplasm ; urinary bladder neoplasms ; urinary calculi ; urography ; urolithiasis