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PubMed1983

Unnecessary intravenous urography in young women with recurrent urinary tract infections.

Intravenous urography was evaluated in 201 young women with recurrent urinary tract infections. In 118 of 121 patients with uncomplicated recurrent infections the intravenous urogram (IVU) was normal. Insignificant abnormalities were found in only three cases. It is concluded that, in order to avoid unnecessary investigation, an additional risk indication should be present to warrant an IVU. The additional risk indications have been identified.

Adolescent↗
PubMed1985

Dehydration in urography: is it really necessary?

The use of dehydration in patients undergoing intravenous urography remains widespread, despite evidence that it may be dangerous and despite lack of evidence of any effect on the urinary concentration of contrast media. In total, 100 patients were studied, having been allocated randomly into two groups, one of which had undergone dehydration, the other group being normally hydrated. No significant difference in the quality of the urograms was detected. It is suggested that the practice of dehydration in preparation is unnecessary and should no longer be undertaken.

Adult↗
PubMed1985

The value of post-void radiographs in excretory urography.

For years, urologists and radiologists have had differing opinions on the value of post-void radiographs in excretory urography. This report is based on a questionnaire sent to the members of the Association of University Urologists and the Society of Uroradiologists. Satisfactory evaluation of bladder function by the use of post-void radiographs is not always possible. Nevertheless, such radiographs have value in selected cases and often play a major role in determining future therapy.

Adult↗
PubMed1985

Comparison of the side-effects of low-osmolar contrast media in intravenous urography.

The subjective side-effects of almost equivalent intravenous iodine doses of the three new low-osmolar contrast media, ioxaglate (Hexabrix), iopamidol (Niopam) and iohexol (Omnipaque) have been recorded and are found to be generally comparable. Urticaria occurred more frequently with ioxaglate than with the other contrast media and there was a tendency for ioxaglate to cause more nausea. Pain at the injection site occurred less often with ioxaglate than with iohexol. If low-osmolar contrast media are to be used in intravenous urography the relative cost of each is important, there being as yet insufficient data concerning the relative incidences of major reactions.

Contrast Media↗
PubMed1987

Ultrasound as an alternative to intravenous urography in prostatism.

Seventy-five patients, with uncomplicated benign prostatic hypertrophy referred for pre-prostatectomy assessment, were studied to determine whether renal tract ultrasound combined with plain films of kidney, ureters and bladder could provide an acceptable alternative to intravenous urography (IVU). All patients had both IVU and ultrasound. Bladder residual urine volumes were calculated by ultrasound measurements. Fifty-nine (78%) patients had normal IVU and ultrasound. Twelve (16%) had both abnormal IVU and abnormal ultrasound. Four (6%) had positive findings on one examination not detected on the other: two of these occurred with ultrasound and two with IVU. Measurement of residual volume of urine in the bladder by ultrasound and IVU is discussed. The combination of ultrasound and a plain radiograph of the urinary tract provides more information and should replace IVU in the preoperative assessment of patients with uncomplicated benign hypertrophy of the prostate.

Aged↗
PubMed1987

Low dose low osmolar intravenous urography.

A prospective double blind randomised trial using 25 ml of Hexabrix 320 (ioxaglate, May and Baker), Niopam 370 (iopamidol, Merck) or Omnipaque 350 (iohexol, Nycomed) intravenous urography was carried out. The results showed no perceptible difference in the diagnostic quality of urograms with each of the media. An additional 25 ml of contrast medium was required by 4% of patients in order to obtain a satisfactory examination. We recommend that a dose of 25 ml of low-osmolar medium be used for all patients with the exception of the obese, those taking diuretics or those who have renal impairment.

Adolescent↗
PubMed1999

Intravenous urography in urinary tract surveillance in carcinoma of the bladder.

AIMS: The need for intravenous urography (IVU) in upper tract surveillance for primary transitional cell carcinoma (TCC) of the bladder is contentious. We reviewed our intensive screening policy in the follow-up of these patients to ascertain if such a policy is required and if specific groups could be identified to rationalise this protocol. METHODS: Review of the clinical and radiological data on 174 patients with a diagnosis of primary TCC of the bladder attending a teaching hospital urology department. RESULTS: Eight upper tract 'lesions' were identified: six TCC and two false-positive examinations using IVU. No link was demonstrable between upper tract recurrence and tumour stage, grade or multiplicity at diagnosis. All had recurrent bladder tumour but four of the six upper tract tumours occurred at 72 months or later. Twenty-nine patients over the study period developed either a dilated pelvi-calyceal system or a non-functioning kidney detected on IVU. CONCLUSIONS: Upper tract TCC can present late and patients with early bladder recurrence and those who do not show a reduction in bladder tumour number at follow-up cystoscopy are most at risk. IVU can probably be safely abandoned in those without local recurrence at 24 months. IVU is sensitive but not specific for upper tract tumour but also yields other relevant clinical information concerning the renal tract. Screening for upper tract metachronous disease should therefore be confined to those with recurrent transitional cell carcinoma of the bladder.

Adult↗
PubMed1992

Evaluation of renal scars by technetium-labeled dimercaptosuccinic acid scan, intravenous urography, and ultrasonography: a comparative study.

The objective of our prospective study was to compare the sensitivity and specificity of ultrasonography, intravenous pyelography, and dimercaptosuccinic acid scan in detecting scarred kidneys. Twenty-seven consecutive subjects with recurrent urinary tract infections, vesicoureteral reflux, scarred kidneys, or a combination of these problems had all three imaging procedures performed. With the total number of scars serving as the gold standard, the sensitivity (94%) and specificity (100%) in identifying renal scars in children were highest for the DMSA scan. Intraobserver (95%) and interobserver (90%) reliability were also high for the DMSA scan. However, the clinical interpretation of the increased sensitivity of the DMSA scan is unknown. Changes on the scan not identified by intravenous urography may not represent true scars. Research into the long-term significance of these scars is indicated.

Adolescent↗
PubMed2002

Prospective comparison of computerized tomography and excretory urography in the initial evaluation of asymptomatic microhematuria.

PURPOSE: The ideal imaging study for evaluation of the upper urinary tract in patients with microhematuria has been debated. We prospectively compared the diagnostic yield of computerized tomography (CT) to excretory urography (IVP) in the initial evaluation of asymptomatic microhematuria. MATERIALS AND METHODS: Between December 1998 and June 2001, 115 patients presenting with asymptomatic microhematuria underwent CT and IVP before cystoscopy. Helical CT images with 5 mm. adrenal and kidney slices with and without contrast material were followed by delayed 5 mm. ureteral contrast images through the bladder base. Each CT and IVP was examined by a radiologist who was blinded to the result of the other imaging study. Diagnostic yields of the imaging techniques were compared using the test of 2 proportions and chi-square analysis. RESULTS: Radiographic abnormalities were noted on CT or IVP in 38 patients. Sensitivity was 100% for CT and 60.5% for IVP, and specificity 97.4% for CT and 90.9% for IVP. CT accuracy was 98.3% compared to IVP accuracy which was 80.9% (p <0.001). A total of 40 nonurological diagnoses were made by CT, including 3 abdominal aortic aneurysms and 1 iliac artery aneurysm. No additional diagnoses were made by IVP. Fewer additional radiographic studies were recommended after CT than after IVP. CONCLUSIONS: The use of CT in the initial evaluation of asymptomatic microhematuria results in better diagnostic yield. In addition, more nonurological diagnoses can be made and less additional radiography is needed to confirm a diagnosis.

Aortic Aneurysm, Abdominal↗
PubMed1985

The role of excretory urography in patients with hypospadias.

The routine use of excretory urography in asymptomatic patients with hypospadias is still a subject of controversy. In 169 patients with hypospadias we reviewed the indications for urographic evaluation and the radiographic results. Of the boys 67 had signs or symptoms of urological disorders, and 102 were asymptomatic and screened prospectively. Abnormalities in those patients with symptoms were significant, which supports the need to continue evaluating patients in this group radiographically. In those boys screened prospectively the incidence of upper tract abnormalities was low. Reflux was discovered in 10 per cent of these patients, although in the majority it was mild and of no surgical consequence. Over-all, reflux remains the single most common urographic abnormality in boys with hypospadias with or without symptoms.

Adolescent↗
PubMed1984

The role of excretory urography in the evaluation of girls with urinary tract infection.

Excretory urography and cystography were done in 200 girls from less than 1 year to 14 years old with a history of urinary tract infections. In 147 girls (73.5 per cent) the excretory urogram and cystogram were normal. Reflux was demonstrated on voiding cystourethrography in 19.5 per cent of the patients. Only 3 patients were found to have a normal voiding cystourethrogram and a significant abnormal excretory urogram. In only 1 patient (0.5 per cent) was an abnormality (an ectopic obstructed ureter) identified, which was amenable to intervention. We conclude that in the evaluation of girls with urinary tract infection an excretory urogram is indicated only in the presence of vesicoureteral reflux.

Adolescent↗
PubMed1983

Should the followup of patients with bladder cancer include routine excretory urography?

This retrospective study was done to determine if patients who present with bladder tumors should be followed with routine excretory urograms to detect subsequent upper tract tumors at an early stage. The charts of 337 patients who have been followed for up to 9 years were reviewed. Excluding 1 patient with invasive transitional cell carcinoma of the distal ureter, no documented renal pelvic or ureteral tumor was discovered in any of the followup data. This finding is in contradistinction to patients who present with upper tract tumors and who are known to have a 44 to 54 per cent incidence of bladder tumor either pre-dating or post-dating the upper tract tumor. We conclude that routine excretory urography is neither cost-effective nor necessary for the followup of patients who present with bladder tumors.

Follow-Up Studies↗
PubMed1981

Comprehensive renal scintillation procedures in spinal cord injury: comparison with excretory urography.

A 131iodine orthoiodohippurate comprehensive renal scintillation procedure was performed and compared to results of excretory urography in 200 spinal cord injury patients. No severe urographic abnormalities were undetected by the comprehensive renal scintillation procedure. Only 1.4 per cent of renal units had greater than minimal pyelocaliectasis or ureterectasis in the presence of a normal radionuclide examination. A relatively large number of abnormalities were detected on the renal scintillation procedure when the excretory urogram was normal. Serial followup will be required to determine the significance of these findings but present data suggest that a comprehensive renal scintillation procedure and a plain film of the kidneys, ureters and bladder may be used for screening upper urinary tract abnormalities in lieu of an excretory urogram. This is particularly advantageous for the spinal cord injury population, since there have been no toxic or allergic reactions reported, no bowel preparation or dehydration is required and there is relatively low radiation exposure.

Humans↗
PubMed1980

Pre-prostatectomy excretory urography: does it merit the expense?

To evaluate the necessity of an excretory urogram before prostatectomy the records of 557 patients admitted to 3 community hospitals in 1977 and 1978 for urinary obstruction were reviewed. Of the entire series 27 per cent revealed urographic abnormalities and 72 significant lesions of the upper urinary tract were noted. An operation other than prostatectomy was necessary in 14 cases. Abnormalities involving the bladder were detected in 29 cases. We conclude that excretory urography remains a sound principle of proper urologic care.

Cost-Benefit Analysis↗
PubMed1978

Screening urography in asymptomatic cryptorchid patients.

Excretory urograms in 140 cryptorchid patients free of associated urologic symptoms are reviewed. Our findings are presented and compared to those of previously reported series. Our results do not indicate a specific indication for the routine use of excretory urography in asymptomatic male subjects with cryptorchidism.

Cryptorchidism↗
PubMed1976

Renal cortical outline evaluation in excretory urography.

Capillary phase nephrogram films and tomography were used to evaluate renal cortical outlines and renal parenchymal masses. The method of examination and the results are presented, showing the capillary phase film to be beneficial and to play a significant role in excretory urography. No increase in the incidence of side effects was noted with the rapid injection technique.

Adult↗
PubMed1976

Some limitations and pitfalls of excretory urography.

A review of some of the more important limitations and pitfalls in the interpretation of excretory urograms is presented. Although there is no infallible method of avoiding interpretive errors it is suggested that the development of good viewing habits, including an orderly and systematic appraisal of each film, coupled with a physiologically oriented approach to film interpretation will reduce mistakes significantly. Similarly, many pitfalls may be circumvented by the simple expedient of close collaboration between urologist and radiologist, and by the reluctance of either to accept urography that is suboptimal by current standards.

Contrast Media↗
PubMed2000

Polymerase chain reaction in clinically suspected genitourinary tuberculosis: comparison with intravenous urography, bladder biopsy, and urine acid fast bacilli culture.

OBJECTIVES: To evaluate the role of urinary polymerase chain reaction (PCR) in the detection of Mycobacterium tuberculosis (MTb) in patients with a clinical suspicion of genitourinary tuberculosis (GUTB) and to compare its sensitivity with intravenous urography (IVU), bladder biopsy, and urine culture for acid fast bacilli (AFB). METHODS: The study was carried out between September 1997 and December 1998 in 42 patients with a clinical suspicion of GUTB. Their clinical features, organ involvement, and investigation results were studied. The diagnostic yield of urinary PCR for MTb and its sensitivity in comparison with routine urine AFB culture, bladder biopsy, and IVU were assessed. RESULTS: There were 25 male and 17 female patients, with a mean age of 31.04 years. Patients suspected of having GUTB most often presented with irritative voiding symptoms. Two patients had abnormal renal parameters. Of the 42 patients clinically suspected of having GUTB, radiologic abnormalities suggestive of GUTB were found in 37 (88.09%); MTb was isolated in the urine AFB culture in 13 (30.95%); bladder biopsy was positive in 11 (45.83%); and urinary PCR for MTb was positive in 34 cases (80.95%). Of 35 cases of proven GUTB, IVU was suggestive of the diagnosis in 32 (91.42%) and MTb was isolated in the urine AFB culture in 13 cases (37.14%). Bladder biopsy was positive in 11 (45. 83%) of 24 patients in whom biopsy was taken, and urinary PCR for MTb was positive in 33 (94.29%). CONCLUSIONS: A high index of suspicion is necessary for a diagnosis of GUTB. In clinically suspected cases, IVU may be suggestive of GUTB, but it is not specific. In the present study, IVU was suggestive in 88.09% of patients. MTb was isolated in the urine AFB culture in only 37.14% of patients, and bladder biopsy was positive in 45.83%. Urinary PCR for MTb was the most sensitive indicator and was positive in 94.29% of patients. It is evident from this series that PCR provides a much faster diagnosis of urinary MTb. It is a rapid, sensitive, and specific diagnostic method and avoids a delay in starting treatment.

Adolescent↗