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

Abstract Objectives: To compare ultrasonography and abdominal radiography with intravenous urography in the investigation of urinary tract infection in men. Design: Prospective study in two hospital departments. Radiological procedures and urological assessments performed on different days by different clinicians Setting: District general hospital. Participants: Consecutive series of men (n=114) referred to the department of urology for investigation of proved urinary tract infection. Interventions: Ultrasonography and intravenous urography of renal tract and assessment of urinary flow rate. Clinical assessment, cystoscopy, urodynamic studies, and transrectal ultrasonography with biopsy. Main outcome measures: Sensitivity and specificity of ultrasonography and abdominal radiography compared with intravenous urography. Results: Important abnormalities were seen in 53 of 100 fully evaluated patients, the most common being a poorly emptying bladder (34). The combination of plain radiographs of kidneys, ureter, and bladder and ultrasonography detected more abnormalities than intravenous urography alone. No important abnormality was missed by this combination (sensitivity 100% and specificity 93%). Conclusions: Ultrasonography with abdominal radiography is as accurate as intravenous urography in detecting important urological abnormalities in men presenting with urinary tract infection. This combination is safer than intravenous urography and should be the initial investigation for such patients. Additional determination of urinary flow rate is useful for the assessment of an incompletely emptying bladder. 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