Little M A, Stafford Johnson D B, O'Callaghan J P, Walshe J J
Departments of Nephrology and Diagnostic Radiology, Beaumont Hospital, Dublin, Ireland.
Nephrol Dial Transplant. 2000 Feb;15(2):200-4. doi: 10.1093/ndt/15.2.200.
Intravenous urography (IVU) is considered an integral imaging component of the nephro-urological work-up in a wide array of clinical settings. At our institution there is an open-access policy with regard to requesting IVU studies.
In a prospective, blinded observational study we undertook to assess the diagnostic yield of IVU with respect to the source of referral (i.e. Urology, Nephrology, GP, A & E, other speciality) and the presenting features, such as renal colic, haematuria, bladder outflow obstruction, recurrent urinary tract infection (UTI) etc. Two hundred consecutive patients were evaluated.
Overall, 23% of tests were positive. There was a highly significant difference in diagnostic yield between the groups (P<0.001 for both referral source and test indication). A positive result was most likely after referral by a kidney specialist (37.1%) and when the test indication was renal colic (42%) or haematuria (32%). The yield was <15% in all other circumstances, with 94.9% and 92.1% of GP- and other hospital speciality-initiated IVUs being negative. When investigating recurrent UTI, 91.7% of tests were negative and 86.2% were negative when the indication was bladder outflow obstruction.
It is suggested that an open access policy for IVU is not justified, especially when cost and the risk associated with contrast media and radiation exposure are taken into account. Our study supports the abandonment of routine IVU in the investigation of UTI and bladder outflow obstruction.
静脉肾盂造影（IVU）在众多临床环境中被视为肾泌尿系统检查不可或缺的影像学组成部分。在我们机构，对于申请IVU检查实行开放获取政策。
在一项前瞻性、盲法观察性研究中，我们着手评估IVU的诊断率，涉及转诊来源（即泌尿外科、肾内科、全科医生、急诊、其他专科）以及临床表现，如肾绞痛、血尿、膀胱流出道梗阻、复发性尿路感染（UTI）等。对连续200例患者进行了评估。
总体而言，23%的检查呈阳性。各组之间的诊断率存在高度显著差异（转诊来源和检查指征的P值均<0.001）。肾专科医生转诊后阳性结果最有可能出现（37.1%），检查指征为肾绞痛（42%）或血尿（32%）时也是如此。在所有其他情况下，阳性率<15%，全科医生和其他医院专科发起的IVU检查分别有94.9%和92.1%为阴性。在调查复发性UTI时，91.7%的检查为阴性，检查指征为膀胱流出道梗阻时，86.2%为阴性。
有人认为IVU的开放获取政策不合理，尤其是考虑到成本以及与造影剂和辐射暴露相关的风险时。我们的研究支持在UTI和膀胱流出道梗阻的检查中放弃常规IVU。
