What is the role of intravenous pyelography (IVP) in the workup of hydronephrosis and hydroureter?

Updated: Dec 16, 2020
  • Author: Dennis G Lusaya, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

The advantages of intravenous pyelography (IVP) in relation to ultrasonography are that IVP has a very low false-positive rate, it can identify the site of obstruction, and it can help detect associated conditions such as papillary necrosis or calyceal blunting from previous infection. [14] Disadvantages are that IVP is more cumbersome to perform and requires the administration of a radiocontrast agent. On balance, IVP can be used to screen for urinary tract obstruction in the following settings:

  • In patients with staghorn calculi or multiple renal or parapelvic cysts, since hydronephrosis is usually not distinguishable from cysts or stones by ultrasonography or CT

  • When CT scanning cannot identify the level of obstruction

  • With suspected acute obstruction due to kidney stones (or less frequently, to other problems, such as a sloughed papilla or blood clot): Dilatation of the collecting system may not be seen at this time, but the presence and location of the obstructing stone can be identified


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