There is evidence that CT cystography (ie, CT of the pelvis performed after retrograde distention of the urinary bladder with iodinated contrast material) is an accurate method of evaluation, with the advantage that the patient need not be moved from the CT scanner [81-83]. Images are to be obtained with a contrast-filled bladder and may be obtained after drainage, although one study in adults suggests that postvoid images may be unnecessary [81]. Multiplanar reformatted images may help in diagnosis [84]. Retrograde Urethrography Patients with blood at the urethral meatus, especially if associated with pelvic fractures or straddle injury, are at risk for urethral injury and disruption. These patients should undergo retrograde urethrography prior to bladder catheter placement [76] and may warrant a cystogram to exclude concomitant bladder injury. Radiography In general, radiography is not appropriate in the initial evaluation of traumatic macroscopic hematuria. Radiographs of the pelvis may reveal pelvic fractures and, in the setting of macroscopic hematuria, raise the possibility of bladder or urethral injury. VCUG VCUG is not appropriate for the initial evaluation of traumatic macroscopic hematuria. If there is concern for urethral injury, dedicated retrograde urethrography is a more appropriate initial imaging test. If there is concern for bladder injury, dedicated CT cystography is a more appropriate initial imaging test. Voiding Urosonography Voiding urosonography is not appropriate for the initial evaluation of traumatic macroscopic hematuria. If there is concern for urethral injury, dedicated retrograde urethrography is a more appropriate initial imaging test. If there is concern for bladder injury, dedicated CT cystography is a more appropriate initial imaging test. Arteriography Arteriography is not appropriate in the initial evaluation of traumatic macroscopic hematuria.
Hematuria Child. There is evidence that CT cystography (ie, CT of the pelvis performed after retrograde distention of the urinary bladder with iodinated contrast material) is an accurate method of evaluation, with the advantage that the patient need not be moved from the CT scanner [81-83]. Images are to be obtained with a contrast-filled bladder and may be obtained after drainage, although one study in adults suggests that postvoid images may be unnecessary [81]. Multiplanar reformatted images may help in diagnosis [84]. Retrograde Urethrography Patients with blood at the urethral meatus, especially if associated with pelvic fractures or straddle injury, are at risk for urethral injury and disruption. These patients should undergo retrograde urethrography prior to bladder catheter placement [76] and may warrant a cystogram to exclude concomitant bladder injury. Radiography In general, radiography is not appropriate in the initial evaluation of traumatic macroscopic hematuria. Radiographs of the pelvis may reveal pelvic fractures and, in the setting of macroscopic hematuria, raise the possibility of bladder or urethral injury. VCUG VCUG is not appropriate for the initial evaluation of traumatic macroscopic hematuria. If there is concern for urethral injury, dedicated retrograde urethrography is a more appropriate initial imaging test. If there is concern for bladder injury, dedicated CT cystography is a more appropriate initial imaging test. Voiding Urosonography Voiding urosonography is not appropriate for the initial evaluation of traumatic macroscopic hematuria. If there is concern for urethral injury, dedicated retrograde urethrography is a more appropriate initial imaging test. If there is concern for bladder injury, dedicated CT cystography is a more appropriate initial imaging test. Arteriography Arteriography is not appropriate in the initial evaluation of traumatic macroscopic hematuria.