Intravenous vs. oral hydration administration for optimal ureteral opacification in computer tomographic urography

Computed tomographic urography (CTU) is the gold standard in the radiologic detection of urinary tract disease. The goals of CTU protocols are to garner fully distended and opacified collecting systems, ureters, and bladder for adequate evaluation. Multiple techniques have been reported in the literature to optimize urinary tract visualization and enhance genitourinary assessment. However, currently no strict guidelines exist regarding the preferred method for optimal urinary tract opacification in CTU.

During the year 2013, a retrospective chart review of CTU examinations were done at either an academic institution where IV hydration was routinely administered or at an outpatient imaging center where oral hydration was preferred. Two attending radiologists experienced in cross-sectional body imaging, retrospectively reviewed all the images, blinded to the method of hydration. The reviewers were asked to quantify ureteral distension as well as to grade urinary tract opacification.

A total of 176 patients and 344 ureters were analyzed. Mean maximal ureteral widths were largest in the mid ureter, followed closely by the proximal ureter. Mean opacification scores showed no statistical significance between hydration methods, stratified by ureteral segment.

Our study results show that oral hydration is easy to implement, produces ureteral distention and opacification similar to CTU studies with IV hydration, without loss of diagnostic quality in our select patient population. Although not statistically significant, the oral hydration protocol is more cost effective, requires less hospital resources, and may be a useful step toward cost-containment strategies pertinent in today's healthcare landscape.