Ultrasonography and abdominal radiography versus intravenous urography in investigation of urinary tract infection in men: prospective incident cohort study

doi:10.1136/bmj.324.7335.454

BMJ 2002;324:454 ( 23 February )

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Ultrasonography and abdominal radiography versus intravenous urography in investigation of urinary tract infection in men: prospective incident cohort study

S J Andrews, specialist registrar in urology, ^a P T Brooks, consultant radiologist, ^b D C Hanbury, consultant urologist, ^a C M King, consultant radiologist, ^b C M Prendergast, consultant radiologist, ^b G B Boustead, consultant urologist, ^a T A McNicholas, consultant urologist. ^a

^a Department of Urology, Lister Hospital, Stevenage, Hertfordshire SG1 4AB, ^b Department of Radiology, Lister Hospital

Correspondence to: D Hanbury Damian.Hanbury{at}lister.enherts-tr.nhs.uk

Objectives: To compare ultrasonography and abdominal radiographywith intravenous urography in the investigation of urinary tractinfection inmen.
Design: Prospective study in two hospital departments.Radiological procedures and urological assessments performed ondifferent days by different clinicians
Setting: District generalhospital.
Participants: Consecutive series of men (n=114) referredto the department of urology for investigation of proved urinarytractinfection.
Interventions: Ultrasonography and intravenous urographyof renal tract and assessment of urinary flow rate. Clinical assessment,cystoscopy, urodynamic studies, and transrectal ultrasonographywithbiopsy.
Main outcome measures: Sensitivity and specificity of ultrasonographyand abdominal radiography compared with intravenousurography.
Results: Important abnormalities were seen in 53 of100 fully evaluated patients, the most common being a poorly emptyingbladder (34). The combination of plain radiographs of kidneys,ureter, and bladder and ultrasonography detected more abnormalitiesthan intravenous urography alone. No important abnormality wasmissed by this combination (sensitivity 100% and specificity 93%).
Conclusions: Ultrasonography with abdominal radiographyis as accurate as intravenous urography in detecting importanturological abnormalities in men presenting with urinary tractinfection. This combination is safer than intravenous urographyand should be the initial investigation for such patients. Additionaldetermination of urinary flow rate is useful for the assessmentof an incompletely emptyingbladder.

What is already known on this topic
Ultrasonography alone is the primary investigation of choice for urinary tract infection in children and women

Ultrasonography has limited sensitivity for renal stones and poor sensitivity for ureteric stones

Urinary infection is less common in men than women and the risk factors are different

What this study adds
Ultrasonography is as effective as intravenous urography in men with urinary tract infection only when it is combined with plain radiography

In men aged over 50 an incompletely emptying bladder is the most common abnormality

In such patients determination of urinary flow rate is particularly helpful

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