Genitourinary Imaging

A 52-year-old woman from Mumbai with a 10-year history of diabetes mellitus type 2 presents with progressive bilateral flank pain, nausea, and a serum creatinine of 3.2 mg/dL (baseline 0.9 mg/dL). Urinalysis shows proteinuria and no hematuria. Renal ultrasound demonstrates bilateral hydronephrosis with dilated collecting systems but normal-caliber ureters. Non-contrast CT abdomen shows no stones or masses. What is the most likely diagnosis?

A 52-year-old man from Delhi presents with acute left flank pain and hematuria for 6 hours. He has a history of recurrent kidney stones. On examination, he is afebrile, BP 140/90 mmHg, and has left costovertebral angle tenderness. Non-contrast CT (NCCT) abdomen shows a 6 mm stone in the left ureter at the level of the pelvic brim with mild hydronephrosis. What is the most likely outcome if conservative management is chosen?

A 68-year-old man from Mumbai presents with painless gross hematuria and lower urinary tract symptoms (frequency, urgency) for 3 weeks. Digital rectal examination is normal. Urine cytology is negative. Non-contrast CT abdomen shows a 4 cm heterogeneous mass arising from the right bladder dome with no invasion of perivesical fat. There is no hydronephrosis or regional lymphadenopathy. What is the most likely diagnosis?

A 52-year-old woman from Mumbai with a history of recurrent urinary tract infections presents with left flank pain and gross hematuria. Contrast-enhanced CT abdomen shows a large left renal mass (8 cm) with heterogeneous enhancement, central necrosis, and invasion into the renal vein. There is no evidence of distant metastases. What is the most likely diagnosis?

A 38-year-old man from Delhi presents with left-sided flank pain and hematuria for 3 days. Vital signs are stable. Urinalysis shows RBCs 50–60/hpf and calcium oxalate crystals. Non-contrast CT abdomen performed urgently shows a 7 mm hyperdense focus within the left proximal ureter with mild upstream hydronephrosis. What is the most appropriate next step in management?