The Evaluation of Hematuria in Adults

To the Editor.—  I have the following comments on the radiological evaluation of adults with hematuria, the subject of the excellent review by Sutton.¹The radiology department should take responsibility for evaluation of the urinary tract above the bladder. To that end, two studies are preferred. First, for kidney parenchyma, computed tomography is the present gold standard for renal imaging, allowing diagnosis, staging, or confident exclusion of renal cell carcinoma. Second, the excretory urogram can usually diagnose urothelial neoplasm above the bladder, particularly if the entire collecting system and ureter are well distended by opaque contrast material. I propose that combining the two examinations is the most effective way to evaluate the urinary tract above the bladder. Combining the two examinations would probably modify the diagnostic algorithm.Such a combined study would begin with a recent plain roentgenogram as a preliminary to an excretory urogram, followed by a