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PubMed1991

Role of ultrasound in the investigation of haematuria after normal intravenous urography and cystoscopy.

The initial investigation of haematuria in the adult includes intravenous urography and cystoscopy. If these investigations reveal no cause for haematuria we propose that renal ultrasound should be considered, and illustrate this with two series of patients from different hospitals (147 from St. Peter's Hospitals, 35 from St. James' Hospital, Balham, London) with primary adenocarcinoma of the kidney.

Aged↗
PubMed1977

Phlebography, urography and lymphography in the diagnosis of metastases from testicular tumors.

The value of lymphography from the foot, urography and phlebography of the inferior vena cava and the left renal and testicular veins in the search for retroperitoneal metastases was investigated in 120 patients with testicular tumors. Phlebography of the left renal and testicular veins was a valuable supplement to the other examinations, so that the combined use of all these methods is recommended in demonstrating metastases and in evaluating the extent of growth and effect of treatment.

Adolescent↗
PubMed1982

Alterations in heart rate and rhythm at urography with sodium diatrizoate.

One hundred and thirty-five consecutive patients referred for urography were monitored electrocardiographically before, during and after injection of 60 ml Hypaque 45% (sodium diatrizoate 45% w/v) over 60 seconds. The injection produced a significant increase in heart rate, while venepuncture alone had no such effect. Twenty-nine (21%) patients developed minor arrhythmias and 6 (4.4%) major arrhythmias following the injection. Major arrhythmias occurred in the older age groups and were more frequent in males. An abnormal baseline rhythm strip had significant predictive value in determining the development of further arrhythmias.

Age Factors↗
PubMed1983

Iohexol compared with metrizoate in urography.

Urography was performed in 20 patients using the new non-ionic contrast medium iohexol (Omnipaque) and in 22 patients using the conventional ionic medium metrizoate (Isopaque) in a randomized, double blind comparison. Iohexol caused significantly less subjective reactions and less tachycardia than metrizoate. No significant difference between the contrast media was observed regarding the influence on blood pressure, hematologic parameters, or clinical chemical parameters in blood and urine. Urographic films of similar and high quality were obtained with both contrast media.

Adolescent↗
PubMed1984

Iohexol and metrizoate in urography in children. Comparison between a non-ionic and an ionic contrast medium.

Urography was performed with the non-ionic contrast medium iohexol in 21 children and with the ionic contrast medium metrizoate in 18 children. The quality of the urograms was good with both contrast media and there was no statistically significant difference between them in this respect. However, the contrast medium attenuation in the collecting system was higher with iohexol than with metrizoate. No renal damage was observed. Only minor adverse reactions were seen with both contrast media and more rarely in the iohexol group, but this difference was not statistically significant.

Child↗
PubMedDate not supplied

Accuracy of ultrasonography compared with urography in detection of intrarenal dilatation in children.

Ultrasonography for detection of postoperative intrarenal dilatation following surgical intervention for vesicoureteral reflux was investigated in 102 children (0-14 years, mean age 4 years and 9 months) over a period of 5 years and was compared with urography. Ultrasonography had a high accuracy for demonstration of even slight intrarenal dilatation caused by postrenal obstruction, while slight and moderate non-obstructive dilatation often was overlooked. The results support the application of sonography for repeated controls of postrenal obstructive dilatation in children with a known medical record in order to diminish their exposure to radiation. The high accuracy does not apply to single sonograms in examination of possible obstruction of unknown origin where some alternative method should be added.

Adolescent↗
PubMedDate not supplied

High dose urography in patients with renal failure. A double blind investigation of iohexol and metrizoate.

The new non-ionic contrast medium iohexol 350 mg I/ml was compared with the ionic contrast medium metrizoate 350 mg I/ml in a double blind, two-group urographic study performed on 20 patients with stable, impaired renal function. A dose of contrast medium of 500 mg I/kg body weight was given to each patient. Iohexol resulted in significantly fewer subjective adverse reactions than metrizoate. A similar image quality was obtained with the two contrast media. No clinically significant difference existed between the two contrast media with respect to influence on blood pressure, pulse or clinical chemical parameters. A tendency to deterioration of renal function after urography was found in both groups, but no difference of statistical significance existed between the two contrast media with respect to possible nephrotoxicity. Inadequate hydration may have been partly responsible for the nephrotoxic effect of the urographic procedure.

Adult↗
PubMedDate not supplied

Low dose urography with a low osmolar contrast medium.

In a double blind study of 100 consecutive patients routinely referred for urography, a conventional contrast medium (Isopaque cerebral) was compared at a dose of 180 mg I/kg body weight with a low osmolar contrast medium (Hexabrix 160) at a dose of 90 mg I/kg body weight. In spite of 50 per cent dose reduction, equally good diagnostic effect was achieved with Hexabrix as with the conventional contrast medium.

Adolescent↗
PubMedDate not supplied

Low dose urography. A clinical comparison of three low osmolar (ratio 3) contrast media.

Three modern low osmolar contrast media (Iopamiro, Omnipaque and Hexabrix) were injected intravenously in 150 patients. They were all effective for urography in a concentration iso-osmolar to blood and with a dose of 90 mg I/kg body weight in patients with normal renal function. In patients with decreased renal function, this low dose is not sufficient and should be doubled. No significant diagnostic differences between the three media were found. The subjective and objective adverse effects were minimal and transient.

Adult↗
PubMed1975

Mechanism of radioactive iodine uptake depression following intravenous urography.

The radioactive iodine (RAI) uptake examination is a standard test for the evaluation of thyroid diseases. For many years it has been known that the results of the RAI are depressed following administration of iodinated contrast media, such as that used for intravenous urography (Williams, 1968; Beierwates, 1956; Slingerland, 1957). The mechanism of this depression is not well documented. It is presumably due to inorganic iodide since it is only inorganic iodide that can be extracted from the blood by the thyroid gland. To study this problem we measured inorganic iodide in bottled contrast media.

Diatrizoate↗
PubMed1985

The old and the new: a study of five contrast media for urography.

Five contrast media, Conray 280 and 420, Urografin 370, Uromiro Sodium 300 and Niopam 370, were compared in a randomised trial involving a total of 482 patients. The best urographic agent was Conray 420 and the worst Conray 280, these control agents defining the ends of the scoring system. Uromiro Sodium 300 was very nearly as good as Conray 420. A non-ionic agent, Niopam 370, scored nearly equal with Urografin 370; both were rather better than Conray 280. There was little difference in minor reactions between the media. No reason was found to prefer non-ionic to ionic agents for general use in urography; indeed for a diagnostic examination the sodium salt of an ionic agent is preferable.

Adult↗
PubMed1991

Ultrasound of the pelvis and renal tract combined with a plain film of abdomen in young women with urinary tract infection: can it replace intravenous urography? A prospective study.

Urinary tract infection (UTI) is common in women and intravenous urography (IVU) is a frequently requested radiological investigation for recurrent UTI. The aim of this study was to assess whether pelvic and renal ultrasound combined with a plain film of the abdomen (KUB) could replace IVU as the initial radiological investigation in young women with recurrent UTI. Ninety-four young women with recurrent UTI who were referred for IVU were studied. Ultrasound of the pelvis and renal tract was performed, and information obtained from ultrasound and KUB was compared with that obtained from the IVU examination. Patient management was altered as a result of radiological investigation in eight cases. A case of staghorn calculus and a case of pelviureteric junction obstruction were diagnosed by both IVU and ultrasound with KUB. An intrarenal abscess was diagnosed by ultrasound in a patient with a normal IVU. In addition ultrasound demonstrated significant findings in the pelvis, including ovarian and uterine abnormalities and an ectopic and an intrauterine pregnancy. In all cases the patient had symptoms referable to the urinary tract and a history of documented UTI. The KUB did not yield any unsuspected finding not diagnosed by ultrasound, but did serve to delineate more clearly the extent of calculus disease in two patients. We suggest that ultrasound of the pelvis and renal tract combined with a KUB should be the radiological investigation of choice in young women with UTI.

Adolescent↗
PubMed1993

Bowel preparation before intravenous urography: is it necessary?

Whether or not bowel preparation should be used before intravenous urography (IVU) remains a controversial issue. Despite strongly held views on both sides there is little scientific evidence to support either viewpoint. We have conducted a prospective randomized study designed to test the hypothesis that adequate bowel preparation before IVU facilitates better quality studies requiring fewer films and consequently less time and a lower radiation exposure. Data on 188 patients were analysed; 90 patients received bowel preparation and 98 received no bowel preparation. There was no difference between the groups in terms of the number of films taken, the duration of the procedure, the visibility of the renal tracts or the overall quality of the studies. The prepared group did have significantly less faecal residue than the unprepared group. However, the renal tract visibility was no greater, as the combination of gas and haustral folds seen after bowel preparation obscured fine detail of the urinary tract as effectively as faecal residue. The hypothesis that adequate bowel preparation before IVU facilitates better quality studies must therefore be rejected.

Cathartics↗
PubMed1994

Iomeprol versus iopromide for intravenous urography.

Iomeprol (B16880) is a new non-ionic tri-iodinated radiographic contrast medium. It was the aim of this double blind randomized phase III clinical trial to compare the local and systemic tolerance of iomeprol-300 (300 mg I ml-1) with the commercially available iopromide-300 (300 mg I ml-1) in a group of 198 patients needing intravenous urography. The contrast medium was injected rapidly into an antecubital vein within 2-3 min in most cases, using a standard dosage of 1 ml kg-1 body weight. The proportion of patients with an allergic diathesis was 25% in the iomeprol group and 17.3% in the iopromide group. There were no life-threatening adverse reactions. Eight patients (8%) receiving iomeprol and 6 (6.1%) receiving iopromide had a sensation of heat related to the injection of contrast medium. Only one patient (1%) in the iomeprol group and two patients (2%) in the iopromide group noted pain on injection. Although the incidence of all other side-effects was relatively high (7% after iomeprol and 11.2% after iopromide) these reactions were generally harmless. The most common symptom was nausea and/or vomiting, which occurred with the same incidence (5%) in both groups. Only one patient in each group developed urticaria or erythema. Vital parameters remained essentially unchanged in all patients. The results suggest that iomeprol is a safe contrast medium, with a tendency to produce fewer side effects than iopromide, which is known to be particularly well tolerated.

Adult↗
PubMed1996

Does bowel preparation improve the quality of intravenous urography?

Many radiology departments continue to use bowel preparation prior to intravenous urography (IVU) despite recent studies questioning its value. This prospective study was designed to test the hypothesis that bowel preparation does not affect the quality of IVU, the number of films taken, or the use of tomography. 144 patients were randomized into three groups; 49 had no preparation, 48 received a mild stimulant laxative (Dulcolax), and 47 took an osmotic laxative (Citramag). The subsequent IVUs were then reviewed by two observers; the control and contrast films were scored for the presence of faecal residue, and the visibility of the renal tract, respectively. Patients were also questioned about the side effects of the two preparations. There was no significant difference in the scores for renal tract visibility in those patients receiving stimulant laxative when compared with the unprepared group. Those receiving the osmotic laxative had significantly less faecal residue but this was at the expense of an increased amount of bowel gas. The osmotic laxative group had significantly higher scores, indicating better visualization of the urinary tract, than the other groups, but no significant reduction in the number of radiographs taken or the use of tomography. This group also reported more side effects. Overall our results suggest that the routine use of a laxative prior to an IVU examination does not decrease the radiation dose and produces some patient inconvenience. The practice therefore cannot be routinely recommended.

Adult↗
PubMed1998

The average dose-area product at intravenous urography in 205 adults.

The intravenous urography (IVU) is the most important and most frequently performed radiological examination in urology. This prospective study determined the dose-area product as a measurement of radiation dose in 205 adult patients undergoing IVU. Average dose-area product was 1017 cGy cm2. An average 3.7 radiographs were obtained per patient. Tomographic views were required in only 8.8% of cases. Radiation dose is dependent not only on the number and size of the obtained radiographs, but on the physical constitution of the patient. The dose-area products measured show a clear relationship to the body weight of the patient.

Adolescent↗
PubMed1998

Comparison of radiation dose from intravenous urography and 99Tcm DMSA scintigraphy in children.

Intravenous urography (i.v.u.) and 99Tcm DMSA scintigraphy are possible alternative diagnostic techniques in paediatric renal investigation. Radiation dose comparisons between them have been complicated in the past by the lack of paediatric data. In this study, evaluations relevant to children are used to compare estimates of effective dose from the two techniques. For the radiographic procedures, standard operating parameters and representative age-dependent values of entrance surface dose were established from recent literature. Conversion factors relating effective dose to entrance surface dose and dose-area product are presented and used to obtain values of effective dose for single radiographs of abdomen, kidneys and pelvis. Suggested i.v.u. procedures consisting of four ("minimum") or eight ("average") radiographs were adopted to derive the effective dose for full i.v.u. examinations. 99Tcm DMSA dose estimates, taken from our published work using an administered activity schedule based on body surface area, are almost constant at about 1 mSv for all children. In comparison, mean i.v.u. doses based on the "average" number of radiographs are similar to DMSA doses for infants (< 1 year) but may be twice as high for older children. Although the differences between procedures at this level of dose do not in themselves provide grounds for preference, when coupled with the lower diagnostic sensitivity of i.v.u. they suggest limitations of this procedure for detection of a renal scar.

Abdomen↗