Intravenous pyelography: the case against its routine use.

Area of Science:

• Radiology
• Urology
• Nephrology

Background:

• Intravenous pyelography (IVP) is an imaging technique used to visualize the urinary tract.
• Its application in various clinical scenarios requires critical appraisal of its diagnostic yield and impact.

Purpose of the Study:

• To critically evaluate the effectiveness of intravenous pyelography (IVP) in four common adult clinical indications.
• To assess the diagnostic yield, accuracy, patient outcomes, and costs associated with IVP use.

Main Methods:

• Literature review of IVP use for specific clinical indications.
• Analysis of diagnostic yield (proportion of clinically useful information).
• Evaluation of accuracy (sensitivity, specificity), patient outcomes, and healthcare costs.

Main Results:

• IVP shows a small yield for detecting abnormalities before prostatectomy and does not prevent ureteral injury during hysterectomy.
• It is not sensitive or specific for screening urinary tract malignancies or for detecting renovascular hypertension.
• IVP use after urinary tract infections in women does not improve outcomes or prevent renal dysfunction.

Conclusions:

• Selective use of IVP is recommended for specific indications like pre-prostatectomy/hysterectomy, post-UTI in women, and suspected renovascular hypertension.
• IVP should be reserved for cases where clinical history and physical examination suggest specific questions that IVP can answer to guide treatment.