EFFECTIVENESS OF SELECTIVE USE OF INTRAVENOUS PYELOGRAPHY IN PATIENTSPRESENTING TO THE EMERGENCY DEPARTMENT WITH URETERAL COLIC

Objective: To determine whether IV pyelography (IVP) is required routi nely for all patients presenting to the ED with ureteral colic, Method s: A randomized prospective study was conducted with 2 patient groups- a routine IVP group, in which all patients underwent IVP, and a select ive IVP group, in which patients were treated, observed, and released without undergoing IVP unless they experienced continued symptoms, The study was performed in a large university-affiliated, community hospi tal ED, Participants were patients aged 18-65 years with signs and sym ptoms consistent with ureteral colic, Results: Among the 40 patients e nrolled in the routine IVP group, 26 had positive studies, 8 of which necessitated hospitalization. Among the 41 patients randomized to the selective IVP group, there were only 19 IVPs performed, of which 6 wer e positive and 4 necessitated hospitalization. Compared with the routi ne IVP group, there were 54% fewer IVPs performed and a 51% lower admi ssion rate in the selective IVP group. Despite the fact that fewer IVP s were performed in the selective IVP group, clinical outcomes in the 2 groups were similar, without significant complication in either grou p, Conclusions: IVPs do not need to be routinely performed for all pat ients presenting to the ED with ureteral colic. The decision to perfor m an IVP may be dictated by symptoms that persist after initial evalua tion and treatment.