Farewell to intravenous urography

We've now stopped doing IVUs in my department!

In place of IVUs, we do noncontrast CT for investigation of urinary stones, and CT urography, where indicated, for haematuria. (Indications for ultrasound are, for now, unchanged).

CT urography is a better test, and more sensitive for detecting stones, urothelial lesions and tumours. The main drawback is radiation dose. However, for stone disease, the dose from a noncontrast CT can be brought to levels similar to that of an IVU using a low-dose technique. For patients with haematuria at high risk for cancer, many of them would have ended up with a CT anyway, and if not I think the extra dose is justified by improved diagnostic confidence and accuracy. As they say, if it was me or one of my relatives .....

The technique is relatively simple, and it is easier to get consistent results than with a conventional IVU. It takes less time, and a morning's work in the IVU room can be completed in the CT scanner in about an hour. One extra radiographer has now been allocated to the CT scanner (in place of the one who used to do IVUs), which has helped to resolve some of our staffing problems. The radiographers are delighted because they didn't like doing IVUs. The urologists are pleased as well.

Our CT urography protocol, on a Toshiba Aquilion 16, consists of a low dose noncontrast run to detect stones, followed by post-contrast imaging using a split blous technique which produces a combined nephrographic and excretory phase image. Imaging is done supine, and repeated in the prone position if ureteric opacification is inadequate.