Who should have intravenous pyelograms before hysterectomy for benign disease?
A review of 493 cases was undertaken to identify which patients undergoing hysterectomy for benign disease had received a preoperative intravenous pyelogram (IVP), an abnormality identified by IVP, and intraoperative ureteral injuries. Intravenous pyelograms were performed on 299 patients (60.6%). Factors significantly associated with obtaining a preoperative IVP included an abdominal approach, uterine size of 12 weeks or greater, and uterine prolapse. Seventy-seven patients (27%) had an abnormal IVP; factors likely to be associated with abnormality included uterine size of 12 weeks or larger or an adnexal mass of 4 cm or larger. Endometriosis, pelvic inflammatory disease, pelvic relaxation, and previous intra-abdominal surgery were not associated with an increased prevalence of abnormal IVP findings. Two ureteral injuries were documented, one in the IVP group (0.3%) and one in the non-IVP group (0.5%). Clinical findings may be used to select for a preoperative IVP those patients who are likely to have abnormalities of importance to the pelvic surgeon.
D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007431:Intraoperative Complications / Q000000981:diagnostic imaging; D008875:Middle Aged; D011300:Preoperative Care; D012306:Risk; D014513:Ureter / Q000293:injuries; D014564:Urogenital Abnormalities; D014567:Urography / Q000009:adverse effects; D014591:Uterine Diseases / Q000000981:diagnostic imaging* / Q000601:surgery