Computed tomography urography for diagnosing bladder cancer

OBJECTIVE To evaluate the use of computed tomography urography (CTU) for diagnosing bladder tumours in patients with macroscopic haematuria and aged >40 years. PATIENTS AND METHODS In all, 200 consecutive patients attending a fast‐track haematuria clinic were assessed using ‘same‐day’ CTU and flexible cystoscopy. Patients were aged >40 years and had macroscopic haematuria with no urine infection. CTU studies were reported by one uroradiologist and scored on a 3‐point scale to quantify the probability of bladder cancer. All flexible cystoscopies were performed by the same cystoscopist with no knowledge of the findings of CTU, and scored using a 3‐point scale. Cystoscopy, pathological findings and CTU were then compared. RESULTS The prevalence of bladder tumours was 24%; when CTU was compared with the histopathological findings, there was one false‐positive and three false‐negative diagnoses, indicating a sensitivity of 0.93 and a specificity of 0.99, with a 0.98 positive and 0.97 negative predictive value for detecting bladder cancer. A review of the three false‐negative cases showed that one was missed on original CTU reporting, the second had the appearance of prostate cancer on CTU and the third was a squamous metaplasia. CONCLUSIONS CTU is an accurate method of detecting bladder tumours in the present patients, and is reliable and accurate for assessing the bladder. Our results support the use of CTU as a first‐line screening tool for this high‐risk group, the use of which will obviate the need for flexible cystoscopy in patients with a negative CTU and allow those with an obvious tumour to be referred directly for rigid cystoscopy and resection. The remaining patients should be referred for flexible cystoscopy. Such a pathway would accelerate patient assessment by using fewer tests and provide a true ‘one‐stop’ clinic, allowing a comprehensive evaluation with a single test for the upper and lower urinary tract.