Excretory urography: trends in clinical use and diagnostic yield Waleska Pabon-Ramos, Elaine Caoili, Richard Cohan, Tausha Stephens, Isaac Francis, James Ellis, Melvyn Korobkin, Matthew Schipper Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, B1D530-UH 5030, Ann Arbor, MI 48109, USA Abstract Objective: To assess for changes in clinical usage and diagnostic yield of excretory urography (EU) following the introduction of CT urography (CTU). Materials and methods: We retrospectively reviewed reports from 6313 EUs performed between July 1995 and February 2006. The specialty of the ordering physi- cian and clinical indication for the study were recorded, as were any collecting system, ureter, or bladder abnor- malities suspicious for urothelial malignancy identified on EU. The proportion of EUs ordered for each indication and the positivity rate for each finding were compared prior to and after 2000, when CTU was introduced. Results: Demand for EU by all physicians has decreased threefold. Since 2000, there has been a decrease in the proportion of EUs performed for all indications: obstruc- tion (P < 0.0001), stones (P < 0.0001), urothelial malig- nancy (P < 0.0001), pain (P < 0.0001), post-operative (P < 0.0001), trauma (P < 0.03), hematuria (P < 0.0001), and urinary tract infection (P < 0.0001). Pro- portional demand by urologists has not changed signifi- cantly (P = 0.105). For exams ordered by urologists, the positivity rate for intraluminal defects within the collecting system and bladder has decreased (P < 0.0001). For exams ordered by non-urologists, there has been no significant change in the positivity rate of urinary tract filling defects (P > 0.05). Conclusion: The number of excretory urograms has decreased dramatically, although the proportion of these studies ordered by urologists is unchanged. The positivity rate of EU findings suggesting urothelial malignancy in the collecting system and bladder has decreased, likely because, with the advent of CTU, urologists have changed their ordering patterns for some clinical indications. Key words: Excretory urography—Urothelial malignancy—Urinary tract—Bladder—Collecting system First introduced in the late 1920s, excretory urography (EU) gained only gradual clinical acceptance until the development of improved tri-iodinated intravenous contrast medium in the 1950s, at which point this study became widely used. Because of EU’s ability to demon- strate the renal collecting systems and ureters non-inva- sively, EU eventually replaced retrograde pyelography and became the mainstay of urinary tract imaging. EU also provided a cursory evaluation of the renal paren- chyma, which was further improved with the addition of nephrotomography. It was the most frequently per- formed urinary tract imaging study in the 1960s. With the advent of CT, the role of EU for the evaluation of renal masses had diminished by the early 1980s [1]. With continued advances in CT technology, there has also been an increase in CT utilization to evaluate the geni- tourinary system, particularly using CT urography (CTU) [2]. Despite this increased utilization, EU is still being requested by clinicians, and is still being performed in radiology departments. The purpose of our study was to assess the degree of change in clinical usage and var- iation in the diagnostic yield for urothelial malignancies of EU following the introduction of CTU at our aca- demic medical center. Materials and methods Data collection Following the Institutional Review Board (IRB) ap- proval and in compliance with the Health Insurance Portability and Accountability Act (HIPAA, USA), pertinent imaging studies and medical records of the Correspondence to: Elaine Caoili; email: caoili@umich.edu ª Springer Science+Business Media, LLC 2009 Published online: 27 June 2009 Abdominal Imaging Abdom Imaging (2010) 35:607–611 DOI: 10.1007/s00261-009-9553-4