Hematuria: Frequently Asked Questions
In general, we prefer the CT urogram – the injection of IV contrast allows us to see small filling defects (tumors) in the draining system of the kidneys. This is particularly important in people with additional risk factors: older patients, prior episodes of hematuria, smokers, history of previous pelvic radiation or chemotherapy.
There are often two reasons why people can’t receive IV contrast: either they have reactions to the IV contrast, or their kidneys don’t work sufficiently to eliminate the contrast after the study is complete.
If you have a reaction to IV contrast (eg, itching, rash), you would receive a Benadryl and prednisone preparation to take by mouth prior. If you have had more serious reactions, such as shortness of breath, a non-contrast CT scan or perhaps an MRI may need to be the course of action.
If your kidney function will not permit IV contrast to be used, there is another test that cn be done called “Retrograde Pyelograms.” Your urologist looks into the bladder using an endoscope, then injects contrast up the ureters. This would avoid absorbing the contrast into your blood system while giving us the information we need.
Yes. A CT scan cannot tell us if the prostate appears to obstruct the urethra or is bleeding into the urethra. They also cannot be relied on to diagnose small urethral lesions or strictures and can easily miss a small cancer of the bladder.
A CT exposes you to radiation, but it is not likely to cause cancer unless this study is done repeatedly. The IV contrast may cause itching or hives. Very rarely will the IV contrast lead to shortness of breath or low blood pressure (anaphylaxis). Cystoscopy will occasionally lead to increased urinary bleeding or an infection. There are rare occasions when cystoscopy can cause injury to the urethra or bladder.