Wasserman N F, Lapointe S, Eckmann D R, Rosel P R
Department of Radiology, Veterans Administration Medical Center, Minneapolis, MN 55417.
Radiology. 1987 Dec;165(3):831-5. doi: 10.1148/radiology.165.3.2446348.
A prospective study of 502 patients referred for assessment of symptoms of bladder outlet obstruction was performed to determine the value of routine intravenous urography (IVU). The purpose was to establish the rate at which significant occult abnormality in the upper urinary tract is detected with IVU alone; to determine to what extent these abnormalities can be predicted from routine clinical and laboratory evaluation, thus allowing better patient selection for IVU; and to recommend alternative imaging modalities. History, physical examination, and routine laboratory studies constituted the preliminary examination. Abnormalities were found in 23% of patients but significant conditions in only 10%. Occult significant abnormalities that would have been missed without IVU occurred in only 1.5% of patients. Most of these could be detected on an abdominal radiograph. Only one malignancy would have been missed without routine IVU. The authors conclude that IVU in the assessment of prostatism should be limited to patients with positive findings in the clinical work-up. An abdominal radiograph is recommended in the others. Significant cost savings can thus be achieved.
对502名因膀胱出口梗阻症状前来评估的患者进行了一项前瞻性研究，以确定常规静脉尿路造影（IVU）的价值。目的是确定仅通过IVU检测上尿路隐匿性重大异常的比率；确定从常规临床和实验室评估中能在多大程度上预测这些异常，从而更好地选择进行IVU检查的患者；并推荐替代成像方式。病史、体格检查和常规实验室检查构成初步检查。23%的患者发现有异常，但只有10%有重大疾病。若不进行IVU，仅1.5%的患者会漏诊隐匿性重大异常。其中大多数可在腹部X光片上检测到。若不进行常规IVU，只会漏诊一例恶性肿瘤。作者得出结论，在评估前列腺增生时，IVU应仅限于临床检查有阳性结果的患者。建议其他患者进行腹部X光检查。这样可以显著节省成本。
