Given the low yield of CTU screening for asymptomatic hematuria in patients <30 years of age, or without risk factors for urinary tract malignancy, US or noncontrast CT may be the first-line imaging examinations in these patients. When there are risk factors present for urinary tract malignancy and the patient is >50 years of age, CTU is the preferred examination [31]. Fluoroscopy Contrast Enema Contrast enema is generally not useful for women with recurrent complicated UTIs. Although it may be utilized for imaging of vesicoenteric fistulas, CT is the primary imaging modality for suspected cases of enterovesical fistulas and has been found to have a higher rate of detection and also capable of identifying the underlying etiology [32,33]. If an enema is performed, water-soluble contrast should be selected rather than barium. Fluoroscopy Cystography Fluoroscopic cystography is generally not useful for women with recurrent complicated UTIs. Although it can delineate bladder diverticuli and vesicoenteric fistulas, CT has supplanted fluoroscopic cystography at most institutions. Fluoroscopy Urethrography Double Balloon Double-balloon urethrography can be useful for demonstration of urethral diverticula, although MRI best assesses the structure and complexity of urethral diverticula, allowing for accurate diagnosis and improved surgical planning. MRI to evaluate for urethral diverticulum has replaced double-balloon urethrography at most institutions. Double- balloon urethrography can be technically difficult and may be uncomfortable for the patient. For this document, it is assumed the procedure is performed and interpreted by an expert. Recurrent Lower Urinary Tract Infections in Females Fluoroscopy Voiding Cystourethrography When a bladder diverticulum is at or near a ureteral orifice, voiding cystourethrography can be considered to evaluate the possibility of vesicoureteral reflux [34].
Recurrent Lower Urinary Tract Infections in Females. Given the low yield of CTU screening for asymptomatic hematuria in patients <30 years of age, or without risk factors for urinary tract malignancy, US or noncontrast CT may be the first-line imaging examinations in these patients. When there are risk factors present for urinary tract malignancy and the patient is >50 years of age, CTU is the preferred examination [31]. Fluoroscopy Contrast Enema Contrast enema is generally not useful for women with recurrent complicated UTIs. Although it may be utilized for imaging of vesicoenteric fistulas, CT is the primary imaging modality for suspected cases of enterovesical fistulas and has been found to have a higher rate of detection and also capable of identifying the underlying etiology [32,33]. If an enema is performed, water-soluble contrast should be selected rather than barium. Fluoroscopy Cystography Fluoroscopic cystography is generally not useful for women with recurrent complicated UTIs. Although it can delineate bladder diverticuli and vesicoenteric fistulas, CT has supplanted fluoroscopic cystography at most institutions. Fluoroscopy Urethrography Double Balloon Double-balloon urethrography can be useful for demonstration of urethral diverticula, although MRI best assesses the structure and complexity of urethral diverticula, allowing for accurate diagnosis and improved surgical planning. MRI to evaluate for urethral diverticulum has replaced double-balloon urethrography at most institutions. Double- balloon urethrography can be technically difficult and may be uncomfortable for the patient. For this document, it is assumed the procedure is performed and interpreted by an expert. Recurrent Lower Urinary Tract Infections in Females Fluoroscopy Voiding Cystourethrography When a bladder diverticulum is at or near a ureteral orifice, voiding cystourethrography can be considered to evaluate the possibility of vesicoureteral reflux [34].