Abdominal ultrasound versus intravenous urography in the evaluation of infravesically obstructed males

In a prospective study intravenous urography (IVP) and abdominal ultrasonography (US) were compared in 100 consecutively admitted male patients with symptoms of infravesical obstruction. No pathology was found in 67 patients on IVP and in 61 patients on US. Both modalities disclosed 5 bilateral, 4 unilateral hydronephroses and one patient with contracted kidneys. IVP found 7 renal masses: one solid tumour, 2 "possibly solid" tumours and 4 "possibly cysts", whereas US found one solid tumour and 16 cysts. Both modalities detected 3 kidney stones, 5 bladder stones and 3 bladder tumours. It is concluded that "imaging" of the urinary tract is only indicated in cases of haematuria, elevated creatinine, history of renal calculous disease and other clinical suspicion of upper urinary tract disease. It is further concluded that US is preferable to IVP in this patient category due to (1) better characterization of renal masses, (2) the possibility of investigating the liver and the retroperitoneum in the same setting, (3) better evaluation of the prostate with respect to size, (4) better evaluation of the bladder, and (5) last but not least for economical reasons. However, bone metastases will be missed.