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PubMed1991

Low osmolar (non-ionic) contrast media versus high osmolar (ionic) contrast media in intravenous urography and enhanced computerized tomography: a cost-effectiveness analysis.

The cost-effectiveness of three alternative policies for the use of intravenous contrast media for urography and enhanced computerized tomography (CT) are analyzed. Alternative #1 is to use high osmolar contrast media (HOCM) in all patients, the historical policy. Alternative #2 is to replace it with low osmolar contrast media (LOCM) in all patients. Alternative #3 is to use LOCM only in the high risk patients. Data on the 6,242 patients who underwent intravenous urography and enhanced CT at the Department of Radiology, Chulalongkorn Hospital in 1989 were used. Both societal and hospital viewpoints were analyzed. The incremental cost-effectiveness (ICE) between #2 and #1 was 26,739 Baht (US$1,070) per healthy day saved (HDS), while the ICE between #3 and #1 was 12,057 Baht (US$482) per HDS. For fatal cases only, ICE between #2 and #1 was 35,111 Baht (US$1,404) per HDS, while the ICE between #3 and #1 was 18,266 Baht (US$731) per HDS. The incremental cost (IC) per patient was 2,341 Baht (US$94) and 681 Baht (US$27) respectively. For the hospital viewpoint the ICE between #2 and #1 was 13,744 (US$550) and between #3 and #1 was 6,127 Baht (US$245) per HDS. The IC per patient was 1,203 Baht (US$48) and 346 Baht (US$14), respectively. From the sensitivity analysis, #3 should be used if the LOCM price is reduced more than 75% (equal to 626 Baht or less) and more than 80% of the patients are able to pay for the contrast media.

Adult↗
PubMed1991

[A comparative evaluation between transrectal echography, venous urography, computerized axial tomography and morphology in patients with prostatic carcinoma].

Prostate cancer is a rather common and severe disease in man. It affects the age beyond 50, a tendency being recently observed towards affecting subjects of younger age. In the early stage the symptoms are scarce and vague. The diagnostic possibilities of ultrasound examination, intravenous urography, computer axial tomography and biopsy specimen examination were compared in patients with prostate cancer. The authors consider the possibilities of transabdominal and transrectal echography for diagnosis of prostate cancer to be superior to those of intravenous urography. H. Watanabe even recommends and uses transrectal echography as screening method. The possibilities and results of transrectal echography and computer axial tomography for evaluating tumor growth and infiltration outside the prostate capsule are compared. Ultrasound examination is recommended as a more exact method, with a view to radical prostatectomy. The good correlation of the echographic patterns with tumor development are also recorded.

Aged↗
PubMed1991

Emergency excretory urography in blunt abdominal trauma.

In a prospective study the authors correlated the degree of hematuria and of blunt abdominal trauma with the results of emergency excretory urography. Urograms were obtained for 37 patients who presented with blunt abdominal trauma, no gross hematuria and at least five erythrocytes per high-power field (hpf) on microscopic urinalysis. Microscopic hematuria was defined as an erythrocyte count of more than 5 and fewer than 50 per hpf. Major trauma was defined as shock (systolic blood pressure of less than 90 mm Hg), fracture of the lumbar spine, the pelvis or the lower ribs, ecchymosis in the flank or acute abdominal injury. Contusions and small subcapsular hematomas were defined as nonsignificant renal injuries; all other renal injuries were defined as significant. Of 17 patients with minor blunt abdominal trauma 14 had fewer than 50 erythrocytes per hpf; none of these had a significant renal injury, whereas 1 of the 3 with more than 50 erythrocytes per hpf did have a significant injury. Of 20 patients with major trauma 5 had a significant renal injury. The authors conclude that microscopic hematuria associated with blunt abdominal trauma but without shock or major nongenitourinary injury does not warrant routine excretory urography.

Abdominal Injuries↗
PubMed1990

Digital radiography versus conventional radiography during excretory urography: our experience.

The authors describe a computed radiographic system employed to generate and archive digital images in intravenous urography. For each exposure the system produces two digital images: the first (left image) simulates a conventional screen-film radiograph, the second (right image); enhances some spatial frequencies and emphasizes the margins of the structures. These images can be modified in their chief parameters and then printed by a laser-printer and archived on optical disks. Four experienced radiologists evaluated digital images with regard to some chief diagnostic parameters and, in 50 patients, they compared digital images with conventional screen-film radiographs and submitted the results to statistical analysis. For some of the chosen parameters, particularly for the evaluation of renal margins before and after contrast medium injection, digital images gave statistically better results than conventional films, while, no statistically significant different was observed for the other parameters. From the results of this preliminary study digital radiography was found to be useful in intravenous urography by reducing the patient's exposition dose, by always obtaining images of good quality, and by enhancing some particular features of the standard image; on the other hand there were many unsolved problems regarding the communicating and archiving system (PACS), because of the slowness of the image transfer procedure, difficulties in data transmission and complexity of referential procedures.

Evaluation Studies as Topic↗
PubMedDate not supplied

[The diagnostic value of simultaneous excretory urography and transuterine pelvic phlebography in a urodynamic study of the upper urinary tract].

A total of 78 females whose complaints failed to fit the scope of known urological and gynecological disorders were under study. Beside the routine patterns, the multiple modality diagnostic technique included radionuclide investigation of the kidneys, determination of the hormonal profile, thermographic examination of inner genital organs, echo scanning of the kidneys and genital organs, hysterosalpingography, simultaneous performance of excretory urography and transuterine pelvic phlebography. X-ray anatomical examinations revealed that the lower part of the ureter was entangled by vaginouterine veins. The side of urodynamic disorders corresponded to that of more manifest varicosis. In those with bilateral disorders more manifest dilatation of the upper urinary tract was noted on the side where varicosis was more pronounced. Based on the data analysis, the authors concluded that simultaneous uro- and phlebographic examinations not only revealed the status of the upper urinary tract, intra- and extraorganic venous systems but promoted a reliable detection of the reasons for urodynamic disorders: the compression due to the enlarged disposed organ or dilated venous vessels. The data on the agreement between of the varicosis-affected side and that of the urine passage through the upper tract was impaired in all patterns of "pelvic varicocele" enables one to reveal some pathogenetic urodynamic failures in females. It can be concluded that simultaneous excretory urography and transuterine pelvic phlebography provide an extensive information on the upper urinary tract, internal genital organs and the pelvic venous system. The method is easily performed in the outpatient settings, avoids serious complications and can be regarded as a prospective additional technique for the examination of females with a gynecological history during urological care.

Diagnosis, Differential↗
PubMed1990

[Urography and renal clearance of contrast media. A randomized comparison of an ionic high-osmolar and a non-ionic low-osmolar contrast medium].

One hundred patients with confirmed or presumedly normal serum creatinine level had an intravenous urography with either an ionic high-osmolar or an non-ionic low-osmolar contrast medium after randomization. Employing Renalyzer PRX 90, the plasma concentration of iodine were determined on blood samples drawn approximately three and four hours after the injection of the contrast medium. From these, the glomerular filtration rate was calculated. The urograms were assessed blindly as regards nephrographic and pyelographic opacification as well as the overall quality as regards the diagnosis was assessed. The clearance was found to vary between 42 and 125 ml x min-1 x 1.73 m-2. No systematic connection of practical significance was found between the clearance and assessment of the urograms. Considerable variation was found in the clearance among not only the poor but also the good urograms. No demonstrable differences of clinical significance were found between the two contrast media. It is concluded that it is not possible to assess clearance from the appearance of the nephrogram and pyelogram or from the overall diagnostic quality in routine urographies regardless of whether ionic high-osmolar or non-ionic low-osmolar contrast media are employed in patients with normal serum creatinine levels.

Adult↗
PubMedDate not supplied

[Urography and the isotopic renogram under diuresis enhance the diagnosis and the indication for therapy in congenital hydronephrosis].

Analysis of a group of 276 patients with congenital hydronephrosis by dysfunction of pyeloureteral function shows that in the most cases the diagnosis has to be established by corroborating the data given by urography, echography, and isotopic renogram. In the cases of controversial hydronephrosis diagnostic, urography and renogram under diuresis induction are very important in practice.

Adolescent↗
PubMed1988

Ultrasonography versus excretory urography: value in urological disease.

Considerable savings in cost and some reduction in gonad dose and contrast medium allergy can be expected if excretory urography can be replaced by real-time ultrasonography as the first examination in upper urinary tract disease. For one year, all patients referred for excretory urography (UG) are first examined with real-time ultrasonography (US) to establish whether UG can be completely replaced by US, or the indications for which US should be the first examination of choice. The results in 200 consecutive patients indicate that both methods sometimes fail, but not in the same patients. A combination of the two may be unbeatable, but uneconomical. The results obtained over one year may give the answer. Hopefully studies at other centres will be initiated to increase the size of the case material.

Cost-Benefit Analysis↗
PubMed1987

[Quality control in urography with iopamidol and iohexol. A parallel comparison].

Iohexol has a slightly higher osmolarity in comparison with iopamidol; therefore it might induce a more pronounced diuretic effect and then a better distension of the excretory pathway. A trial was carried out in two groups of 50 patients with normal renal function who underwent urography, namely with 50 ml (15 gI) of iopamidol and of iohexol. No significant differences in the evaluated parameters (nephrography, calyces, pelvis, ureters and bladder) have been found. Both contrast media allowed to perform good quality urographies.

Adolescent↗
PubMed1987

[RARE-MR urography: a fast nontomographic imaging procedure for demonstrating the efferent urinary pathways using nuclear magnetic resonance].

RARE-MR-Urography is a new fast data acquisition technique for magnetic resonance imaging. As a non-tomographic approach to the morphology of the urinary system, image information is similar to intravenous X-ray urography. As the sequence results in a heavily T2-weighted image displaying aqueous fluids, application of contrast agents is not necessary. Image quality is demonstrated by an exemplary case. Basic technical details and possible indications are discussed.

Adult↗
PubMed1985

[Sequential angio-urography (SAU) with photographic image subtraction].

Urography was performed in 250 patients: the technique of bolus injection of a large quantity of contrast medium was used in every case. By means of rapid seriography the early vascular phase was shown and reproduced, when necessary, with image subtraction. The abdominal aorta and the renal arteries were demonstrated in 97.6% of cases. Altogether, in 34.4% of cases the existence of pathological conditions non demonstrable by conventional urography was ascertained; in 12.4% of cases extrarenal pathology was diagnosed. This technique is suggested to be used sistematically, as an alternative to DSA, where digital equipments are not available.

Adolescent↗
PubMedDate not supplied

Iohexol vs. diatrizoate. A comparative study in intravenous urography.

A randomized double-blind study comparing the use of iohexol with diatrizoate in intravenous urography was performed in 435 patients in nine centers. Contrast media were evaluated for safety, incidence of adverse side effects, and efficacy. Multiple hematologic and biochemical parameters were observed, as well as blood pressure and pulse, at intervals before and after injection. Severity, nature, and duration of side effects were recorded together with the attending physician's clinical assessment. Coned radiographs of the kidneys were done immediately after injection and were repeated at 1-, 5-, 10-, and 20-minute intervals. Films were evaluated for quality of image. A significantly higher number of excellent studies were obtained with iohexol than with diatrizoate. Remarkably few side effects and adverse reactions reported for iohexol establish the safety and suitability of this nonionic contrast medium for intravenous urography.

Adult↗
PubMed1983

Comparison of iohexol with metrizoate in urography. A single blind parallel investigation.

Iohexol 300 and 350 mg I/ml were compared with Na-Ca-Mg metrizoate 350 mg I/ml at the dose levels 200 and 350 mg I/kg body weight. Independent of dosage, iohexol caused a lower incidence of patient reactions during urography than metrizoate. The intensities of the patient reactions in the iohexol groups were consistently milder than those in the corresponding metrizoate groups. Both contrast media gave equally good diagnostic quality, and no unexpected changes in laboratory or physiologic components occurred. Both tolerability and patient reactions indicate that iohexol should be preferred to metrizoate in urography.

Adult↗
PubMed1984

Newer contrast agents for urography.

New low-osmolality ratio-3 contrast media have been shown to have less toxicity than currently used contrast media. In intravenous excretory urography, these agents give significantly higher urinary iodine concentrations, produce less diuresis, and are better tolerated by patients because of fewer unpleasant side effects. These newer low-osmolality contrast media have significant advantages in intravenous urography.

Animals↗
PubMedDate not supplied

[Intravenous urography after radiosurgical treatment of uterine cancer (stages T1 and T2). Normal transient features and urological complications (author's transl)].

The same radiosurgical treatment was given to 108 cases of stages T1 and T2 uterine cancers, and consisted of curietherapy followed by an extended colpohysterectomy with lymph node resection (Meigs operation) Intravenous urography was performed during operation in all patients, and at least one postoperative intravenous urography was also carried out. Stricture of the pelvic ureter was discovered postoperatively in 50.9% of cases, with or without subjacent stasis: this type of image is transient and disappears within eight months. A lymphocele can cause images showing signs of bladder pressure. Ureteral and vesical complications of a true and definitive nature are extremely rare.

Female↗
PubMed1984

[Panurography -- a new method of combination excretory and micturitional urography].

To diagnose a vesicoureteral reflux, a new examination X-ray procedure was developed avoiding bladder catheterization: panurography. Panurography is a combination of excretion and micturition urography which for screening purposes can be performed in a single investigation without bladder catheterization. Recent advances in uroradiological imaging techniques with growing application of low-dose large-format image intensifier urography (14" image intensifier) not only reduce radiation exposure to less than 20% of that in conventional film-screen radiography, but also permit obtaining voiding cystograms which include the whole urinary tract from the kidneys to the urethra in children. Voiding conditions are improved by means of a comfortable micturition seat coupled with a uroflowmeter which automatically triggers exposures by a 10 cm-camera at preselected intervals as long as a measurable urine flow exists.

Adult↗
PubMed1983

Iohexol compared with diatrizoate in pediatric urography.

Iohexol (300 mg I/ml) was compared with meglumine-Na diatrizoate (290 mg I/ml) in a randomized, single blind, parallel investigation in pediatric urography. Urography with iohexol was performed in 25 infants and with diatrizoate in 26. No changes of clinical importance were observed in blood or urine. No patient reactions were observed in the iohexol group, while 3 patients in the diatrizoate group had reactions assessed to be caused by the contrast medium. Iohexol gave somewhat better diagnostic information than diatrizoate.

Adolescent↗
PubMedDate not supplied

[Value of preliminary intravenous urography. Apropos of errors by default in the ultrasonic diagnosis of renal tumors].

Ultrasound recordings were conducted in 181 patients with renal tumors during a period of three and a half years. A precise diagnosis of a renal tumor mass had not been made in 4 cases, definition of the nature of the lesion requiring further explorations. It is emphasized that in these 4 cases an intravenous urography examination was either not performed (1 case), ultrasound being the initial examination, or was imperfectly conducted and interpreted (3 cases). It is concluded that a correctly performed and interpreted intravenous urography investigation should occupy a preliminary stage before any ultrasound imaging of the urinary tract.

Adult↗