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PubMed1987

Comparative value of ultrasonography, computerized tomography, angiography and excretory urography in the staging of renal cell carcinoma.

From 1982 to 1985, 225 patients with renal cell carcinoma were treated by nephrectomy. To evaluate the diagnostic significance of ultrasonography in predicting tumor stage the results of ultrasonography, computerized tomography, renal angiography and excretory urography were compared to the histopathological findings. Since local tumor extension has a considerable impact on the operation strategy evaluation of the T classification was of particular interest. All 4 diagnostic procedures were performed in 73 of the 225 patients. The T stage was determined correctly by ultrasonography in 77.8 per cent of the patients, while the tumor was not identifiable in only 0.6 per cent. Computerized tomography was almost as reliable as ultrasonography (the T stage was predicted correctly in 72.3 per cent of the examinations). In contrast, the tumor was staged correctly by angiography in only 57.2 per cent of the patients and by excretory urography in only 59.2 per cent. From these results ultrasonography appears to be an effective, noninvasive, inexpensive and safe procedure to evaluate the T stage of renal tumors.

Angiography↗
PubMed1986

The value of excretory urography in staging bladder cancer.

Disagreement exists about the accuracy of excretory urography in the staging of bladder cancer. During a 10-year period 38 of 524 patients with carcinoma of the bladder had ureteral obstruction on excretory urography at the time of the initial diagnosis. All 38 patients had lamina propria invasion and 35 had muscle invasion at staging transurethral resection. Of those patients 22 had exploratory laparotomies, 11 after 4,000 to 5,000 rad. Of the patients undergoing laparotomy 55 per cent had metastases. Ureteral obstruction at the time of initial diagnosis of bladder cancer usually indicates muscle invasion and/or metastases.

Humans↗
PubMed1984

Comparison of computerized tomography and excretory urography in detection and evaluation of renal masses.

The ability of excretory urography and computerized tomography to detect renal masses was compared in 120 consecutive cases. Computerized tomography consistently provided more information than excretory urography, usually was able to distinguish renal tumors from cysts and provided additional useful information regarding staging of renal neoplasms and the presence of unsuspected associated pathological conditions.

Contrast Media↗
PubMed1980

The role of excretory urography and cystoscopy in the evaluation and management of women with recurrent urinary tract infection.

We examined the roles of excretory urography and cystoscopy in the evaluation and management of 153 otherwise healthy women seen consecutively with recurrent urinary tract infections. The excretory urograms were entirely normal in 89 per cent of the patients; the abnormalities were incidental findings with no influence on subsequent management. These results, combined with the known expense and risks inherent in the use of iodinated radiologic contrast material, suggest that excretory urography be limited to those patients possessing other risk factors. These include a history of unexplained hematuria, obstructive symptoms, neurogenic bladder dysfunction, renal calculi, analgesic abuse, severe diabetes mellitus or bacteriologic evidence of rapid recurrence suggesting bacterial persistence within the urinary tract or an enterovesical fistula. On the other hand, cystoscopy under local anesthesia has essentially no risks and occasionally will yield information helpful in future management.

Adolescent↗
PubMed1980

The health and cost implications of routine excretory urography before transurethral prostatectomy.

After critically reviewing 601 patients who had undergone transurethral resection of the prostate we conclude that the routine use of excretory urography is not indicated. In the vast majority of patients with only obstructive symptoms or acute urinary retention excretory urography is an expensive test, with an extremely low incidence of useful information. However, its selective use is indicated in cases in which hematuria or a history of renal disease coexists with obstructive symptoms. The time has arrived for physicians to re-evaluate the practices of the past. We all need to participate actively and to make specific recommendations, not generalities. We believe that if the guide lines suggested herein are considered the annual health costs would be decreased by an estimated $75,000,000 and the quality of urologic care would not be jeopardized.

Adult↗
PubMed1978

Renal pseudotumor on urography secondary to gallbladder empyema.

A case of gallbladder empyema is presented, which opacified initially on excretory urography and then on nephrotomography, mimicking a renal mass. Correct diagnosis was accomplished by angiography and ultrasound examination. With normal renal function gallbladder visualization on urography is indicative of a gallbladder abnormality.

Aged↗
PubMed1975

Continuous infusion urography in unilateral hydronephrosis.

In cases of unilateral hydronephrosis the urine concentration of contrast medium, for example diatrizoate, depends on the remaining renal function, the rate of turnover in the obstructed renal pelvis and the function of the contralateral kidney. Contrast medium for a single injection or a short infusion time is rapidly excreted by the normal contraleteral kidney, without allowing high enough plasma levels long enough for sufficient urine concentrations in the hydronephrotic kidney. This excretion rate can be compensated for by continuous infusion urography for several hours with large doses of contrast medium (up to 1,250 ml. 30 per cent diatrizoate). This method was theoretically computerized, tested in animals experiments and clinically used in 11 patients. It can improve the diagnostic possibilites of excretory urography, especially in cases of unilateral obstruction, and can minimize the need for retrograde pyelography with its known complications.

Aged↗
PubMed1996

Evaluation of the clinical safety and efficacy of iobitridol (Xenetix) in intravenous urography.

The aim of this study is to report on the clinical safety and diagnostic efficacy of iobitridol (Xenetix) in intravenous urography compared to iohexol (Omnipaque) or iopamidol (Iopamiro). A total of 120 patients underwent intravenous urography (i.v.u.); 60 received Xenetix and 60 either Omnipaque (30 patients) or Iopamiro (30 patients) according to the center where they were treated. Clinical safety was assessed by the reporting of adverse events and diagnostic efficacy was evaluated. Warmth sensation was the most commonly reported adverse event. Two cases of nausea and vomiting were reported. Concerning diagnostic efficacy, 72-74% of the i.v.u. examinations were rated good or excellent by the physician. These studies confirm that Xenetix is a suitable contrast agent for i.v.u.

Contrast Media↗
PubMed2001

Functional, dynamic, and anatomic MR urography: feasibility and preliminary findings.

RATIONALE AND OBJECTIVES: The authors assessed the feasibility of using magnetic resonance (MR) urography to acquire functional, dynamic, and anatomic information in human subjects with normal and hydronephrotic kidneys. MATERIALS AND METHODS: In subjects known to have or suspected of having hydronephrosis, split renal filtration fractions were measured with a customized magnetization-prepared, inversion-prepared gradient-recalled echo sequence to determine the T1 of flowing blood in the inferior vena cava and aorta before and after contrast medium administration and in the renal veins and arteries after contrast medium administration. Multiple timed sets of coronal fast spoiled gradient-echo 70 degrees flip-angle images were acquired before and after contrast medium administration to derive MR renograms from changes in the signal intensity of the cortex and medulla. Precontrast T2-weighted images were obtained with a three-dimensional fast spoiled gradient-echo maximum intensity projection pulse sequence, and postcontrast T1 maximum intensity projection images were also obtained to depict the renal anatomy. RESULTS: Split filtration fraction differentiated normal from hydronephrotic kidneys. MR renograms depicted vascular, tubular, and ductal phases and differentiated between normal and hydronephrotic kidneys (P < .05, n = 20). Contrast medium dose correlated with the peak of the cortical signal intensity curves on the renogram (r = 0.7, P < .0005; n = 20). The sensitivities for the visual determination of hydronephrosis and unilateral delayed excretion of contrast material were both 100%, and the specificities were 64% and 85%, respectively. CONCLUSION: The preliminary findings show promise for the use of MR urography in the comprehensive assessment of renal function, dynamics, and anatomy.

Adult↗
PubMed1996

Comparison of iodixanol with iohexol in excretory urography.

RATIONALE AND OBJECTIVES: We compared the safety and efficacy of iodixanol, a nonionic, dimeric, iodinated contrast agent, with that of iohexol, a monomeric agent, in adult excretory urography. METHODS: The study used a randomized, double-blind, parallel-comparison design to evaluate image quality, vital signs, laboratory values, and adverse reactions. Seventy-five patients from each of two centers were included. One third received iodixanol at 270 mg I/ml, one third received iodixanol at 320 mg I/ml, and one third received iohexol at 300 mg I/ml. The dose for every patient was 1 ml/kg of body weight. The radiographs were interpreted and evaluated for quality by the primary investigator at each center. There were no important differences among the three groups in terms of demographics. RESULTS: Evaluation of each phase of the radiographic study showed almost uniform good-to-excellent opacification, with no significant differences among the three agents. No significant differences existed for the three groups in terms of vital signs, hematology, blood and urine chemistry, and injection discomfort. There were no deaths or serious reactions during the study, nor was there a statistically significant difference among the number of adverse events for the three agents. CONCLUSION: Iodixanol at both 270 and 320 mg I/ml proved to be a safe and effective contrast material for intravenous urography. In this study, its profile was essentially indistinguishable from that of iohexol at 300 mg I/ml.

Adolescent↗
PubMed2002

Magnetic resonance urography in patients with neurogenic bladder dysfunction and spinal dysraphism.

OBJECTIVE: To investigate the reliability of magnetic resonance urography (MRU) using heavily T2-weighted very fast spin-echo sequences in imaging the upper urinary tract in patients with spinal dysraphism and neuropathic bladder dysfunction. PATIENTS AND METHODS: Patients with neuropathic bladder dysfunction secondary to spinal dysraphism may have gross spinal deformity, which makes assessing the urinary tract extremely difficult by ultrasonography or intravenous urography. The study included 50 patients (median age 33 years, range 19-52) with a median (range) Cobb's angle of 60 (0-240) degrees. No contrast medium was given but all patients received 20 mg of intramuscular frusemide 20-30 min before MRU. RESULTS: Thirty-five patients had previous ultrasonography, during which only 42 kidneys and no ureters were visible. Of the 94 renal tracts, MRU visualized all kidneys and 86 (89%) ureters. There was good agreement amongst observers on assessing the kidneys and pelvicalyceal systems (kappa > or = 0.61) but only moderate agreement on evaluating the ureters (kappa < or = 0.61). There was disagreement on normality vs renal parenchymal scarring in 14 (15%) kidneys, about no dilatation vs dilatation of the pelvicalyceal system in 14 (15%) systems and about no dilatation vs dilatation of the ureter in 20 (22%) ureters. The overall quality of the MRU images was rated highly, with a mean (range) score of 4.6 (3-5). CONCLUSION: MRU provides a reliable noninvasive technique for imaging the upper tract in patients who were previously difficult to investigate.

Adult↗
PubMed2000

Early report: comparison of breath-hold MR excretory urography, Doppler ultrasound and isotope renography in evaluation of symptomatic hydronephrosis in pregnancy.

AIM: To compare assessment by MR excretory urography (MREU), Doppler ultrasound and isotope renography of women with symptomatic hydronephrosis in pregnancy and to define its cause. MATERIALS AND METHODS: Eleven women at 19-34 weeks of gestation were studied prospectively with gadolinium-enhanced breath-hold gradient echo MREU and transabdominal Doppler ultrasound compared with a 'gold standard' of isotope renography employing frusemide challenge. All studies were performed within 24 h, were reported independently in a blinded fashion and employed clearly defined criteria. Obstetric and infant outcomes were obtained. RESULTS: There were no adverse reactions to gadolinium administration in pregnancy and no adverse obstetric or infant outcomes. Three of the 11 women were unable to tolerate the complete MREU protocol. Ultrasound indices could not be used to predict ureteric obstruction as shown by isotope renography. MREU agreed with renographic findings in five of the six cases with obstruction and in two without obstruction. MREU directly demonstrated hydronephrosis to result from extrinsic compression of the ureter between the gravid uterus and iliopsoas muscle. CONCLUSION: MR excretory urography is a promising technique which affords equivalent functional and additional anatomical information to isotope renography. It is more accurate than Doppler ultrasound in the assessment of ureteric obstruction in pregnancy.Spencer, J. A. (2000). Clinical Radiology55, 446-453.

Contrast Media↗
PubMed2004

Multidetector CT urography: techniques, clinical applications, and pitfalls.

For two decades, computed tomography (CT) has challenged intravenous urography (IVU) in the evaluation of urinary tract abnormalities. Compared with IVU, CT is more sensitive and specific in the detection and characterization of a variety of urinary tract disorders, including renal masses and urolithiasis. The last purported advantage of IVU has been its ability to depict subtle and mucosal abnormalities of the urothelium. Now, using multidetector CT (MDCT), this challenge has been overcome. In this article, we review the current role of MDCT urography in the evaluation of the urinary tract.

Artificial Intelligence↗
PubMed2002

Impact of magnetic resonance urography on preoperative diagnostic workup in children affected by hydronephrosis: should IVU be replaced?

PURPOSE: The aim of this study was to determine the role of magnetic resonance urography (MRU) in preoperative diagnostic workup of children with hydronephrosis in a prospective clinical study with comparison of MRU, standard diagnostic investigations, and intraoperative findings. METHODS: Thirty-one children with hydronephrosis secondary to different causes underwent ultrasound scan (US), intravenous urography (IVU), micturation cysto-urethrography (MCU), isotope nephrography (ING) and MRU. For MRU the authors performed sagittal and coronal halve-Fourier SSFSE scans in a 1.5 Tesla MR system. T1- and T2-weighted sequences were used in axial orientation to improve morphologic information. In 24 patients, preoperative data were compared with intraoperative findings. RESULTS: Comparison of the different imaging modalities proved MRU to be able to provide more detailed information about the correct localization of stenoses along the urinary tract and the morphology of renal parenchyma. MRU showed the highest concordance of all imaging modalities with intraoperative findings. CONCLUSION: As a reliable investigation, MRU has the potentials to replace IVU in preoperative diagnostic workup of hydronephrosis in childhood.

Adolescent↗
PubMed2006

[Modern diagnostic assessment of the upper urinary tract using multislice CT urography].

The advent of Multislice Computed Tomography (MSCT) has made evaluation of the entire urinary tract with high-resolution sections during a single breath-hold a reality. Acquisition of multiple thin overlapping slices provides excellent two-dimensional (2D) and three-dimensional (3D) reformations of the urinary tract. The concept of "Multislice CT Urography (MSCTU)" has emerged from this technical improvement. As a result, a wide range of pathologies inside and outside the urinary tract can be identified. During the last several years, MSCTU has challenged intravenous urography (IVU) in the evaluation of urinary tract abnormalities. Compared with IVU, MSCT(U) is more sensitive and specific in the detection and characterization of a variety of urinary tract disorders, including renal masses and urolithiasis. The main advantage of IVU has been its ability to offer excellent delineation of pelvicalyceal and ureteral anatomy and to depict subtle uroepithelial abnormalities. MSCTU has already shown promising results for overcoming this challenge. Optimal opacification and distension appear to be an essential requirement for a thorough evaluation of the collecting system. Dedicated preparation strategies have been developed to meet these technical difficulties. The biggest disadvantage of MSCTU is the significant radiation exposure. For broad routine clinical application, there is still a need for dose reduction protocols despite the ongoing technical developments in MSCTU. In this article, we outline the different concepts of technical processing for MSCTU and summarize the current role of MSCTU in the evaluation of the upper urinary tract.

Carcinoma, Transitional Cell↗
PubMed1983

[Pharmacokinetic aspects of excretory urography in children].

Contrast media able to pass through the kidney were a major advance in the field of radiodiagnostics. Excretory urography is usually performed using metabolically-inactive substances which accumulate in the kidney and kidney-pelvis. A two-compartment model has always been used so far for pharmacokinetic evaluation of this. However, in doing so, the kidney pelvis was not taken in account. A further compartment was therefore added to this model which enables all the physiological processes demonstrated by excretory urography to be included in the evaluation. With this model, blood and urine levels can be used at the same time to calculate pharmacokinetic variables, as shown in 6 pediatric patients. In addition to the cumulative excretion of urine and blood levels of the contrast medium, the concentrations of the latter in the renal pelvis are shown. Particular attention is paid to the effects of two important factors in investigations using contrast medium--diuresis and total body fluid volume.

Adolescent↗
PubMed2003

Is intravenous urography a prerequisite for renal shockwave lithotripsy?

PURPOSE: To determine whether intravenous urography (IVU) is a prerequisite for shockwave lithotripsy (SWL) of renal stones by addressing whether using non-contrast-enhanced CT (NCCT) instead of IVU for delineating urinary tract anatomy is associated with post-SWL complications. PATIENTS AND METHODS: Thirty-eight patients treated by SWL (Econolith 2000) for radiopaque renal stones underwent either IVU or NCCT. Twenty patients with normal urinary tracts or with mild hydronephrosis proximal to the stone on urography comprised the IVU group. Eighteen patients who underwent NCCT and plain abdominal (KUB) films and had urinary tract systems similar in appearance to the IVU group comprised the NCCT group. The two groups were of similar mean age (45.75 years, range 24-73 years; and 49.0 years, range 26-72 years, respectively) and had a similar mean stone size (10.1-10.2 mm). Patients with internal ureteral or nephrostomy catheters were excluded. Information on episodes of intractable renal colic, urinary tract infections, and hospitalization was recorded at follow-up 2 to 6 weeks post-SWL. RESULTS: The IVU and NCCT patients had similar mean stone fragmentation rates (80% and 74%, respectively) at 2 to 6 weeks post-SWL. Four IVU patients (20%) had intractable renal colic. One NCCT patient (5.5%) had a urinary infection. Complication and hospitalization rates in the two groups were not significantly different (P = 0.34; Fisher' exact test). CONCLUSIONS: Using only NCCT before SWL was not associated with higher complication rates. Thus, IVU is not a prerequisite for SWL of radiopaque renal stones in patients with a normal urinary tract anatomy as seen on NCCT.

Adult↗
PubMed2005

Intravenous urography in evaluation of asymptomatic microscopic hematuria.

BACKGROUND AND PURPOSE: In 2001, the American Urologic Association Best Practice Policy Panel recommended CT or intravenous urography (IVU) over ultrasonography as the initial imaging modality in patients with asymptomatic microhematuria. We here present results of a study initiated many years ago and completed prior to 2001 that provides information pertinent to the use of IVU as the initial imaging modality for such patients. PATIENTS AND METHODS: This study compared the results of IVU and ultrasonography in patients 40+ years of age who were referred to a single urology department for evaluation of microscopic hematuria between 1994 and 2000. There were 290 patients who agreed to participate by undergoing ultrasonography in addition to IVU; 247 completed both tests. There were 81 men and 166 women with a mean age of 56.4 years (range 40-86 years). Thirty patients (12%) were smokers. RESULTS: A renal lesion or mass suggestive of tumor was found in 8 patients (3.2%); 3 patients had this finding on the IVU examination and 5 on ultrasonography. None of the patients had such a lesion/mass on both examinations. Two patients with suspect lesions were ultimately found to have renal-cell carcinoma. Both of the patients with renal cancer had a suspect lesion on the ultrasound examination but not on the contemporaneous IVU. CONCLUSION: Intravenous urography may miss lesions/masses that lead to a diagnosis of upper-tract neoplasia.

Adult↗