Daniel Dolewski MD, Presenter: Nothing to Disclose

Christopher Joseph Lisanti MD, Abstract Co-Author: Royalties, Lippincott Williams and Wilkins

Michael Berven MD, Abstract Co-Author: Nothing to Disclose

Megan Skinner MD, Abstract Co-Author: Nothing to Disclose

Michael Jason Reiter MD, Abstract Co-Author: Nothing to Disclose

Ryan Becton Schwope MD, Abstract Co-Author: Nothing to Disclose

The American College of Radiology (ACR) Appropriateness Criteria recommends CTU in patients with RUTIs if the patient has one or more of 19 risk factors. The literature cited is over 30 years old and showed 6% of RUTIs patients with major structural abnormalities and all these had risk factors. The purpose of this study is to assess the utility of CTU and risk factors in adults under 50 years of age with RUTIs.

In this HIPAA compliant IRB approved study, 1521 CT Urograms were performed in adults under the age of 50 between January 5, 2007 and March 28, 2012. Inclusion criteria were a clinical history of RUTIs and/or 3 documented UTIs in 12 months in females or a single UTI in males. Findings in the upper and lower urinary tracts were recorded and the clinical notes, if available, were reviewed for presence of risk factors according to ACR guidelines and what clinical intervention, if any, was undertaken.

74 patients met inclusion criteria (66 female; 8 male). Average age: 28.7 years. 69/74 (93.2%) clinical records were available. 100% (69/69) had one risk factor (usually prior UTI), and 63.8% (44/69) had at least two risk factors. The following findings required intervention: 1 (1.4%) renal cell carcinoma and 1 (1.4%) obstructing ureterolith felt unrelated to RUTIs requiring a stent. The following findings not requiring further intervention were: 8 (10.8%) simple cysts; 12 (16.2%) nephrolithiasis; 3 (4.1%) cortical scarring; 3 (4.1%) complete renal atrophy; 1 (1.4%) papillary necrosis; 8 (10.8%) partial duplicated collecting systems; 1 (1.4%) complete duplicated collecting system; 1 (1.4%) mildly dilated bilateral ureters felt to be physiologic; 3 (4.1%) bladder diverticula; 3 (4.1%) bladder filling defects and 3 (4.1%) wall thickening with negative cystoscopy. 1 mildly dilated ureter, 1 bladder filling defect and 1 bladder wall thickening had no follow-up clinical records available.

2.8% of adults under 50 years of age with RUTIs and at least one risk factor had urinary abnormalities identified on CTU requiring intervention, however, none of these abnormalities were determined to be causal to the patient’s RUTIs.

CTU has a low yield in adults under 50 years of age with RUTIs.  Presence of risk factors does not appear to result in a higher yield than prior research studies.

Dolewski, D, Lisanti, C, Berven, M, Skinner, M, Reiter, M, Schwope, R, Utility of CT Urography (CTU) in Recurrent Urinary Tract Infections (RUTIs) in Adults under 50 Years of Age.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13020248.html