EFFICACY OF PRONE POSITIONING DURING INTRAVENOUS UROGRAPHY IN PATIENTS WITH HEMATURIA OR UROTHELIAL TUMOR BUT NO OBSTRUCTION

Rationale and Objectives. The authors prospectively explored the effic acy of using prone positioning during intravenous urography to improve diagnostic visualization and eliminate the need for retrograde pyelou reterography in patients with no obstruction but with hematuria, histo ry of urothelial tumor, or abnormal results of urine cytology. Materia ls and Methods. Prone radiography was added to the usual intravenous u rography protocol in 510 patients (347 men, 163 women) without urinary tract obstruction. Interpretations of intravenous urograms and recomm endations 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 radiography in 100 of 510 patients (19.6%) (95% confidence interval, 82.1, 118). R etrograde pyeloureterography was obviated in 46 of 510 patients (9.0%) (95% confidence interval, 33.1, 58.9). The prone image was most helpf ul in evaluating the distal ureters (sacral and pelvic segments). Conc lusion. Prone patient positioning during intravenous urography is usef ul when complete visualization of the upper urinary tract is desirable . Obtaining the additional image is cost-effective, even when only a f ew retrograde pyeloureterography studies are obviated.