Intravenous pyelography: the case against its routine use.
OBJECTIVE
To critically appraise four common uses of intravenous pyelography in adults.


METHODS
We reviewed the literature on the use of intravenous pyelography for four clinical indications.


METHODS
We analyzed the literature to determine the proportion of intravenous pyelograms producing clinically useful information (yield) in four clinical situations. The best estimate of its accuracy (sensitivity and specificity) for associated pathologic findings was determined. The implications of using the test on the outcomes of patients and costs were evaluated.


RESULTS
The yield of significant abnormalities in patients having prostatectomy is small; intravenous pyelography does not specifically indicate ureteral obstruction, and is not sensitive or specific enough for screening for urinary tract malignancies. Many false-positive results, little benefit, and significant costs can be expected. When used before hysterectomy, intravenous pyelography does not reduce injury to the ureters, and the yield of unexpected abnormalities is small. The use of the test to screen for unexpected anatomic abnormalities in adult women after urinary tract infections has not led to improved outcomes or prevention of impaired renal function. Acquired causes of obstruction will be suggested by the history or physical examination. In hypertensive adults, intravenous pyelography is not accurate enough in detecting renal artery stenosis or in predicting favorable outcomes of renal artery surgery. Also, large costs are generated by high false-positive rates, and candidates for successful surgery are not reliably identified.


CONCLUSIONS
Selective use of intravenous pyelography is recommended for patients before prostatectomy or hysterectomy, in women after urinary tract infections, and in adults whose hypertension may have a renovascular cause. Use should be reserved for patients whose history and physical examination raise specific questions for which this test could provide an answer that would affect treatment.
Mushlin
A I
AI
University of Rochester School of Medicine and Dentistry, Rochester, New York.
Thornbury
J R
JR
D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging; D007044:Hysterectomy; D008297:Male; D015201:Meta-Analysis as Topic; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011468:Prostatectomy; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging; D014567:Urography / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data