Excretory urography: trends in clinical use and diagnostic yield

To assess for changes in clinical usage and diagnostic yield of excretory urography (EU) following the introduction of CT urography (CTU).

We retrospectively reviewed reports from 6313 EUs performed between July 1995 and February 2006. The specialty of the ordering physician and clinical indication for the study were recorded, as were any collecting system, ureter, or bladder abnormalities suspicious for urothelial malignancy identified on EU. The proportion of EUs ordered for each indication and the positivity rate for each finding were compared prior to and after 2000, when CTU was introduced.

Demand for EU by all physicians has decreased threefold. Since 2000, there has been a decrease in the proportion of EUs performed for all indications: obstruction (P < 0.0001), stones (P < 0.0001), urothelial malignancy (P < 0.0001), pain (P < 0.0001), post-operative (P < 0.0001), trauma (P < 0.03), hematuria (P < 0.0001), and urinary tract infection (P < 0.0001). Proportional demand by urologists has not changed significantly (P = 0.105). For exams ordered by urologists, the positivity rate for intraluminal defects within the collecting system and bladder has decreased (P < 0.0001). For exams ordered by non-urologists, there has been no significant change in the positivity rate of urinary tract filling defects (P > 0.05).

The number of excretory urograms has decreased dramatically, although the proportion of these studies ordered by urologists is unchanged. The positivity rate of EU findings suggesting urothelial malignancy in the collecting system and bladder has decreased, likely because, with the advent of CTU, urologists have changed their ordering patterns for some clinical indications.