Are dedicated bladder films necessary as part of intravenous urography forhaematuria?

Objective To determine the use and assess the value of full-bladder films d uring intravenous urography (IVU) which, despite the widespread availabilit y of flexible cystoscopy, remain part of IVU in many radiology departments. Materials and methods A telephone survey of all Scottish radiology departme nts where IVU is regularly used showed that half routinely included a full- bladder film in the series. The reports of all IVU over 2 years in the auth ors' department were analysed retrospectively. The index urogram of all pat ients with bladder tumours confirmed during this period was reviewed indepe ndently by three observers, and together with the initial radiological repo rts was correlated with the cystoscopic and histological findings. Results From 2625 patients, 139 (5.2%) IVU reports commented on the bladder ; 1423 patients presented with no haematuria. None of the patients without haematuria, where a comment was made about the bladder, had pathological ev idence of a tumour. Overall 121 of 464 (26%) new bladder tumours were diagn osed on IVU before cystoscopy. Multiple tumours were always undetected and large tumours were often overlooked. Conclusions Despite its continuing popularity, IVU is a poor means of ident ifying bladder tumours and routine views of the full bladder should be aban doned.