Intravenous Urography

An intravenous urogram (IVU) is often used for the evaluation of hematuria, for the purpose of identifying a renal mass, renal or ureteral stone, upper tract urothelial filling defect, and hydroureteronephrosis. Furthermore, the functional nature of the IVU often allows the physician to distinguish between obstructive and nonobstructive hydronephrosis.

The most common reasons for obtaining an IVU in a woman with pelvic organ prolapse are to detect hydronephrosis and to evaluate for ureteral obstruction from previous pelvic surgeries. Moreover, although ureteral injuries during hysterectomy occur in 0.1% to 2.5% of cases, it has never been shown that routine preop-erative IVU in patients with pelvic prolapse actually reduces the incidence of ureteral injury. Although the incidence of hydroureteronephrosis is low in the prolapse patient, it does increase with worsening pelvic prolapse, and is more common with uterine prolapse than with vault prolapse. As such, routine IVU in the setting of pelvic organ prolapse is not necessary unless one is concerned about urothelial pathology.

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