Efficacy of prone positioning during intravenous urography in patients with hematuria or urothelial tumor but no obstruction.
OBJECTIVE
The authors prospectively explored the efficacy of using prone positioning during intravenous urography to improve diagnostic visualization and eliminate the need for retrograde pyeloureterography in patients with no obstruction but with hematuria, history of urothelial tumor, or abnormal results of urine cytology.


METHODS
Prone radiography was added to the usual intravenous urography protocol in 510 patients (347 men, 163 women) without urinary tract obstruction. Interpretations of intravenous urograms and recommendations for retrograde pyeloureterography were made before and after evaluation of the prone image.


RESULTS
Confidence in the urographic interpretation was improved with acquisition of the prone radiograph in 100 of 510 patients (19.6%) (95% confidence interval, 82.1, 118). Retrograde pyeloureterography was obviated in 46 of 510 patients (9.0%) (95% confidence interval, 33.1, 58.9). The prone image was most helpful in evaluating the distal ureters (sacral and pelvic segments).


CONCLUSIONS
Prone patient positioning during intravenous urography is useful when complete visualization of the upper urinary tract is desirable. Obtaining the additional image is cost-effective, even when only a few retrograde pyeloureterography studies are obviated.
Kowalchuk
R M
RM
Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, USA.
Banner
M P
MP
Ramchandani
P
P
Forman
H P
HP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000652:urine; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005260:Female; D006417:Hematuria / Q000000981:diagnostic imaging* / Q000473:pathology / Q000652:urine; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000652:urine; D014556:Urine / Q000166:cytology; D014567:Urography / Q000379:methods*; D019459:Urothelium
D003287:Contrast Media