The 'one-shot' intravenous pyelogram: is it indicated in unstable trauma patients before celiotomy?

Although contrast studies are valuable in assessing renal function and identifying injury in trauma victims, we questioned the use of "one-shot" intravenous pyelograms (IVPs) in unstable patients. Retrospective review of 926 IVPs performed over 4.5 years identified 239 preoperative "one-shot" IVPs in patients for whom evaluation in the radiology suite was felt to be unsafe. Of these IVPs, 53 had abnormal findings and 183 had normal findings. Three patients' records were lost. In the 53 patients with abnormal IVP results, injuries were confirmed at surgery in 39. In three cases, an abnormal appearing IVP provided the only indication for renal exploration leading to nephrectomy or revascularization. In the remaining 14 patients with abnormal IVPs, the kidneys were found to be normal at surgery. In the 183 patients with normal IVPs, 14 had injuries that required nephrectomy, renal vein ligation, renorrhaphy, or perinephric drainage. The IVP assessment of contralateral renal function played no role in the decision to perform nephrectomy.

Eight percent of patients with normal IVP findings had renal injuries not detected by "one-shot" IVP, and 26% of patients with abnormal IVP findings had no intraoperative evidence of renal injury. Delaying definitive therapy to obtain a preoperative "one-shot" IVP in an unstable patient is not warranted.