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Introduction
The procedure
- X-Ray + Contrast
- Other names
Indications
1 – Hematuria
2 – Renal Colic
- Contrast allergy
- Hepatorenal syndrome
- Thyrotoxicosis
- Pregnancy
- Raised serum creatinine
Advantages of IVU
- Low cost
Limitations of IVU
- Moving around
- Bowel preparation
- Metformin
Preliminary film (control film)
Technique
- Dye injection
- Taking x-rays
Films
inspect:
inspect :
look for:
- Residual urine
- Clinical Information:
- Description:
- Impression:
Description
- A supine view of the abdomen demonstrates a normal bowel gas pattern, with no evidence
of free intraperitoneal air, pathologic calcification, or soft tissue mass. The bony structures
are unremarkable.
- Prompt excretion is noted bilaterally into normal renal collecting systems and ureters, with
no evidence of intraluminal filling defect or mucosal irregularity.
Participants: Consecutive series of men (n=114) referred to the department of urology for investigation
of proved urinary tract infection.
Results: Important abnormalities were seen in 53 of 100 fully evaluated patients, the most common being
a poorly emptying bladder (34). The combination of plain radiographs of kidneys, ureter, and bladder
and ultrasonography detected more abnormalities than intravenous urography alone. No important
abnormality was missed by this combination (sensitivity 100% and specificity 93%).
Materials and Methods: One hundred and eleven consecutive patients with clinically suspected urinary
tract calculi were selected for study. At first they underwent sonography along with x-ray KUB and then
IVU. We evaluated the sensitivity, specificity, negative /positive predictive values and accuracy of US X-
ray KUB combination and IVU for detecting renal / ureteric calculi while final diagnosis (gold standard)
obtained from the results of clinical course/urological procedures.
Results: Out of 111 consecutive patients 46 (41 %) were normal and 65 (59 %) patients had KUB calculi.
US along with x-ray KUB detected 59 patients and missed 6 patients and likewise IVU detected 61
patients out of 65 patients. Sensitivity, specificity, and accuracy of both these modalities are almost
similar with IVU having slightly upper edge.
Conclusion: IVU remains an important investigation in the assessment of calculus and other causes of
urinary tract obstruction. Ultrasound in combination with x-ray KUB is an excellent modality having almost
similar diagnostic capability as IVU in detecting KUB calculi along with many more significant
advantages, as it has less radiation dose, relatively inexpensive, universally available, easily applicable
and high diagnostic efficacy.
NCCT vs IVU
N Khan, Z Anwar, AM Zafar, F Ahmed, et al. A comparison of non-contrast CT and intravenous
urography in the diagnosis of urolithiasis and obstruction. African Journal of Urology .
2012; 18(3). http://www.ajol.info/index.php/aju/article/view/84103 . Accessed April 5, 2014.
Subjects and methods: This is a retrospective review of radiological and clinical data of patients with
suspected urolithiasis or ureteric obstruction who had both NCCT and IVU performed within 30 days of
each other. The data were analyzed using the statistical packages Epidata™ and SPSS™. The number
of calculi, presence of hydronephrosis and hydroureter, cysts and ureteric wall thickening were
evaluated in both NCCT and IVU. Additionally, perinephric stranding in NCCT and delayed excretion in
IVU were also evaluated.
Results: Of the 139 patients (87 male and 52 female), 102 patients (73.4%) had positive findings on
NCCT and 71 (51.1%) on IVU. On NCCT 133 stones were detected in 80 patients (57.6%), 67 (48.2%) in
the kidney, 63 (45.2%) in the ureter and 3 (2.2%) in the bladder. The findings on NCCT were
hydronephrosis in 43 (31%), hydroureter in 34 (24.5%), perinephric stranding in 7 (5%), ureteric wall
thickening in 4 (2.8%), renal mass and renal cyst in 1 (0.7%) each. On IVU 86 stones were detected in
46 patients (33.1%), 53 (38.1%) in the kidney, 31 (22.3%) in the ureter and 1 (1.4%) in the bladder. The
findings on IVU were hydronephrosis in 31 (22.3%), hydroureter in 18 (13%), delayed excretion in 5
(3.6%), renal cyst and ureteric wall thickening in 1 (0.7%) each. Incidental findings were more common
on NCCT (23/139, 16.6%) than IVU (2/139, 1.4%).
Conclusions: NCCT compared with IVU had a higher detection rate for ureterolithiasis,
especially for stones in the distal ureter. An added benefit of NCCT was the detection of significant additional findings.