Is intravenous urography indicated in a young adult with hematuria?

OBJECTIVES

Published reports are devoid of U.S. studies investigating the role of the intravenous urogram (IVU) in adult patients of differing ages with hematuria. To evaluate the efficacy of the IVU in patients less than 55 years old, a retrospective analysis was performed.

METHODS

The records of all patients (n = 800) undergoing IVU in an inner city hospital from January 1991 through October 1994 were reviewed for age, gender, race, urinalysis data, and cystoscopic and biopsy findings. Age greater than 55 years, recent trauma, and known malignancy were exclusion criteria. Hematuria was the indication for IVU in 128 of 800 patients. Eight (6.2%) of 128 patients had inadequate chart information, leaving a total of 120 evaluable charts.

RESULTS

We stratified the 120 patients by age, degree of hematuria (gross versus microscopic), and gender. The younger group (17 to 40 years old) included 64 patients (53%) and the older group (41 to 55 years old) 56 patients (47%). Gross hematuria was reported in 65 patients (54%), whereas 55 (46%) had microscopic hematuria. Men accounted for 78 patients (65%) and women for 42 (35%). The majority of patients were African-Americans (100 [83%] of 120). Abnormal findings were seen in 17 (14%) of 120 patients. The IVU alone provided no diagnosis of immediate consequence. There was no significant difference in findings between the age groups (P = 0.61), gross and microscopic hematuria (P = 0.28), and men and women (P = 0.59). Contrast reactions occurred in 3 (2.5%) of 120 patients.

CONCLUSIONS

In this inner city population younger than 55 years of age, the usefulness of the IVU for the evaluation of hematuria is questionable. It did not establish a diagnosis, modify the subsequent evaluation, or change the therapy in any of our patients.