A non-contrast CT is usually sufficient in delineating where the stone lies, the presence of obstruction in the ureter or pelvicalyceal system. Because contrast is not used and given that it has a much higher ability to detail , this has superseeded IVP. After saying that, some parenchymal stones or nephrocalcinosis or indeed, distinguishing some phleboliths from true ureteric stones may be difficult to see on a non-contrast CT. This is where an exctretory phase CT urogram may be helpful or the good old IVU.

IVU has served the urological community faithfully for over 75 years and has now retired. There are very few real indications of IVU for stones and obstruction, however it is hardly ever used now. We have shown that patients with stones treated by SWL not doing an IVU does not impact outcome or increase morbidity.

The Ct Scan is Faster, not uses contrast, have better anatomic resolution, shows bladder wall, less invasive (not IV needle).

see the article:

Intravenous urography is died. Long live the computerized tomography!

http://zl.elsevier.es/es/revista/actas-urologicas-espanolas-292/articulo/la-urografia-intravenosa-ha-muerto-13154912

A non-contrast spiral CT scan is a golden standard for stone detection, especially in a patient with history of renal colic. Contrast is indicated in cases of caliceal stones and possible ESWL treatment, or in cases with pyelolithiasis and hydronephrosis in a young patient with congenital PU stenosis. Other rare indications for contrast CT are congenital malphormations associated with urolithiasis or hydronephrosis.

IVU can give an estimation of renal anatomy, in order to decide on treatment options such as ESWL or PCNL especially on a lower pole calyx stone. While a CT scan would provide more accurate stone measurement and better sensitivity in revealing the stone, more information on surrounding anatomy such as bowel or spleen if the PCNL solution is opted. A CT pyelography would provide the maximum information, but at a maximum cost and radiation. If one radiology study was to be used in every case maybe CT scan would be the choice, but IVU is not dead yet.

For minimal invasive surgery such as PCNL and also for open surgery we need an imaging modality that show renal anatomy and defining place of stone .in this situations Spiral CT scan is better than IVU ,but in ESWL or TUL a good ultrasonography and KUB may provide enough information and don't need IVU or CT scan although for diagnosis and followup of obstructive uropathy IVU is still a good option. .

when at the UVJ - usually you can see it easily with US and TRUS. No need for radiation. We have to be careful with the overuse of CT - RADIATION

Yes. It is necessary to perform ivu in renal or vuj calculus. It helps in planning for management. Theoritically ct ivu is best but not perform routinely.ct reserved in complicated stone disease.

We still go for IVP as CT is expensive in our country

but IVP needs contrast - and US is also cheap- or?

I agree that CT has replaced IVP in most situations. It is important to note that for recurrent stone formers, the radiation exposure from repeated stone protocol CT scans can be substantial, and if possible, a low-dose protocol scan should be used.

See http://www.ncbi.nlm.nih.gov/pubmed/20308448

@ frauscher; us is cheap,no need of contrast and no radiation.but us has got limitation too.better for intial study,but not for pllaning of management. U kneed a anatomical and functional studies for management. Hope u got it.

@Sadrollah Mehrabi; i disagree with. for eswl u have to know the functional status of the kidney. usg and kub xray do not provide that.eswl can only planned by certain factors.ct with iv contrast is best in that. if cost is an issue,as in our country ivu still serves the purpose.

Conventional CT is currently the gold standard. However, dual energy CT (DECT)provides the same diagnostic information as well as additional benefits of determination of stone composition (as uric acid or non-uric acid- with likely further distinction between stone types in the future), stent/stone color contrast, and identification/architecture of mixed calculi. DECT does not increase radiation exposure, scan time, or cost. It is likely conventional CT will eventually be replaced by DECT as the gold standard for stone imaging.

@ maria: whats ur opinion about ivu?

IVP (or IVU) is essentially no longer used at our institution. Although it is useful when CT is not available and does likely provide less radiation exposure, the patient is still exposed to intervenous contrast and its associated risks (allergic reaction, contrast induced nephropathy, etc.). CT is able to provide much more anatomic detail and is adequate for diagnosis of urolithiasis. Other findings such as hydronephrosis/ureter and perinephric stranding can also be reliably diagnosed on non-contrast CT; these findings in combination with laboratory values are frequently adequate to allow for determination of appropriate treatment. Further, in patients presenting with acute renal colic CT allows for alternative diagnosis (e.g. diverticulitis). I agree with the prior posts in this thread- IVP was a great tool, but has been replaced by a better one.

IN   emergency condition  for detecting  function of kidney   especially in operation room    and for evaluation anatomy of collecting system in kidney IVU still is choice and for interventional of collecting system  IVU  is more helpful for urologist

IVU is nearly 80 years old and it should retire now. we have written two papers to address this issue.

A paradigm shift in imaging for renal colic - Is it time to say good bye to an old trusted friend?

Ahmed F, Zafar AM, Khan N, Haider Z, Ather MH.

Int J Surg. 2010;8(3):252-6. doi: 10.1016/j.ijsu.2010.02.005.

Is an excretory urogram mandatory in patients with small to medium-sized renal and ureteric stones treated by extra corporeal shock wave lithotripsy?

Ather MH, Faruqui N, Akhtar S, Sulaiman MN.

BMC Med. 2004 Apr 28;2:15.

I personally use IVU sparingly may be every 500 CT KUB. Ultrasound and x-ray KUB is an option if radiation or cost is an issue. 

I agree that CT is the gold standard.

Especially by measuring stone density treatment planning can be optimized.

However US has a high accuracy, is safe and cheap.

regards

ferdinand

If the UVJ stone is suspected to be within a uretrocele, IVP is indicated.

There is a paradigm shift in imaging for urolithiasis, there are number of papers indicating this change

1. A paradigm shift in imaging for renal colic - Is it time to say good bye to an old trusted friend?

Ahmed F, Zafar AM, Khan N, Haider Z, Ather MH.

Int J Surg. 2010;8(3):252-6.

2. Is an excretory urogram mandatory in patients with small to medium-sized renal and ureteric stones treated by extra corporeal shock wave lithotripsy?

Ather MH, Faruqui N, Akhtar S, Sulaiman MN.

BMC Med. 2004 Apr 28;2:15.

There is no more any indication for an IVU for urolithiasis, Non contrast CT suffice in most cases and if further anatomical details are needed a CT urogram provides much more advanced information than IVU