Certain Diagnostic Phases of Excretion Urography

SINCE Von Lichtenberg and Swick, in 1929, made intravenous urography a practical procedure, this method is proving of more and more value in the diagnosis of urinary tract pathology. At first it was thought that this procedure would be of use chiefly in those cases in which cystoscopy and retrograde urography were difficult or impossible. However, as time went on, the utilization of this method not only by the urologist but by the internist, etc., as well, proved of incalculable value in picking up both urinary tract and contiguous pathology, such as perinephritic abscess and retroperitoneal tumors. At the Michael Reese Hospital, in Chicago, where the work for this paper was carried out, the use of intravenous urography as a routine procedure is urged upon the internists, general surgeons, and gynecologists in any and all cases in which the diagnosis is in the least obscure. As a result, the amount of work on the genito-urinary service has more than doubled in the past four years, while the number of cystoscopies with retrograde urograms has decreased about 40 per cent. Since our contribution is only part of a general symposium on Intravenous Urography, no attempt will be made to cover all of its phases, but we will confine ourselves to three main points, as follows: (1) The superiority of intravenous urography over retrograde urography in certain well-defined cases; (2) the use of intravenous urography in the differential diagnosis of intraperitoneal and retroperitoneal tumors, and (3) the value of intravenous urography in the diagnosis of ureteral stones, especially those of the radiotranslucent variety, accompanied by unilateral anuria. 1. The Superiority of Intravenous Urography over Retrograde Urography in Certain Well-Defined Cases Case 1. The first case is that of a normal intravenous urogram. There would be nothing unusual in this, were it not for the fact that this young man entered the hospital with all of the symptoms of acute appendicitis. In the routine study of the case, a moderate number of red cells were found in the microscopic urinalysis, some twenty to thirty to the high-powered field. A scout film of the urinary tract disclosed several questionable shadows, any one of which might possibly be a right ureteral calculus. Formerly, this patient would have been subjected to a cystoscopy and the passage of a shadowgraph catheter into the right ureter, with perhaps a right-sided pyelogram. However, a normal intravenous urogram ruled out the possibility of kidney or ureteral pathology, and at operation a retrocecal inflamed appendix was removed. Case 2. A man of 25 entered the hospital with right lower quadrant pain, vomiting, temperature of 100° F., and leukocyte count of 12,000. He had exquisite tenderness along the course of the right ureter and the urine showed microscopic blood and pus.