U J 03 - All-2.pdf 600 | Is Bowel Preparation Necessary Before kidney-Ureter-Bladder Radiography and Intravenous Urography? Farid Dadkhah,1 Mohammad Reza Safarinejad,2 Erfan Amini,1 Mohammad Soleimani,1 Alireza Lashay1 Purpose: Materials and Methods: - Results: Mean total score for visualization of the urinary system on plain and contrast images did P - images (P = .001). Conclusion: Keywords: castor oil, cathartics, radiography, urography Corresponding Author: Mohammad Reza Safa- rinejad, MD P.O. Box: 19395-1849, Tehran, Iran Tel: +98 21 2245 4499 Fax: +98 21 2245 6845 E-mail: info@safarinejad. com Received August 2011 Accepted January 2012 1Department of Urology, Shahid Modarress Hospital, Urology and Nephrology Research Center, Shahid Be- heshti University of Medical Sciences, Tehran, Iran 2Private Practice of Urology and Andrology, Tehran, Iran MISCELLANEOUS Miscellaneous 601Vol. 9 | No. 3 | Summer 2012 |U R O LO G Y J O U R N A L INTRODUCTION B centers to improve the image quality and visibility of the uri- - and impair the quality of images. (1-9) suffering from functional constipation. We conducted this prospective randomized trial to assess - tion. MATERIALS AND METHODS - patient prior to inclusion and the local medical ethics com- mittee approved the study protocol. (10) - - - - - - cal indications. - vided into 5 anatomical regions, including the right renal, left renal, right ureteral, left ureteral, and pelvic regions, and quality in this study (Table 2).(11) - tient belonged to. - Table 1. Rome III diagnostic criteria for functional constipation.* 1. Must include two or more of the followings: Straining during at least 25% of defecations Lumpy or hard stools in at least 25% of defecations Sensation of incomplete evacuation for at least 25% of defecations Sensation of anorectal obstruction or blockage for at least 25% of defecations Manual maneuvers to facilitate at least 25% of defecations (eg, digital evacuation, support of the pelvic floor) Fewer than three defecations per week 2. Loose stools are rarely present without the use of laxatives 3. Insufficient criteria for irritable bowel syndrome *Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis. Bowel Preparation Prior to KUB and IVU | Dadkhah et al 602 | - tion method as not unpleasant, unpleasant, or very unpleas- RESULTS - - P = .253, Mann- Whitney U - P = .101, Mann-Whitney U test). 4). subjects. Mean total score for visualization of the urinary P = .694, Mann-Whitney U test). - P = .463, Mann-Whitney U - sus 16.1%, P severe abdominal pain occurred in 21 (23.1%), nausea in 9 (9.9%), and vomiting in 4 (4.4%) patients. Thirty-seven (40.6%) patients reported the effects of castor oil as unpleas- ant and 15 (16.5%) as very unpleasant. DISCUSSION - ureter-bladder radiography in evaluation of the ureteral and (12) Table 2. European Commission Guidelines for evaluation of image quality. Image criteria before administration of contrast medium Criterion 1 Reproduction of the area of the whole urinary tract from the upper pole of the kidney to the base of the bladder Criterion 2 Reproduction of the kidney outlines Criterion 3 Visualization of the psoas outlines Criterion 4 Visually sharp reproduction of the bones Image criteria after administration of contrast agent Criterion 1 Increase in parenchymal density (nephrographic effect) Criterion 2 Visually sharp reproduction of the renal pelvis and calyces (pyelographic effect) Criterion 3 Reproduction of the ureteropelvic junction Criterion 4 Visualization of the area normally traversed by the ureter Criterion 5 Reproduction of the whole bladder area Miscellaneous 603Vol. 9 | No. 3 | Summer 2012 |U R O LO G Y J O U R N A L Bowel Preparation Prior to KUB and IVU | Dadkhah et al - ning technique, is becoming more common in investigation urography has a high diagnostic accuracy and may simplify (13) - performed in many radiologic centers. to improve the diagnostic quality of the image. A survey at administered at 14 of 15 departments.(2) Schuster and col- (5) - and associates reported moderate or severe side effects in (1) effects of the laxatives to be unpleasant or very unpleasant. (2) of fecal peritonitis.(14) preparation are common and can be especially devastating for bedridden and elderly patients. - high incidence of adverse effects and discomfort. We found - - - trast images in this subgroup of patients. - dressed previously in several clinical trials.(1-9) They con- - decrease the fecal residue at the expense of patient discom- fort. create excessive gas that compromises the image quality and diagnostic accuracy.(6) Guo and colleagues selected 3 laxa- necessary for satisfactory visualization of the urinary system Table 3. Patients’ characteristics. Gender, n (%) Male Female 60 (65.9) 61 (64.2) .805* 31 (34.1) 34 (35.8) Constipation, n (%) Yes No 17 (18.7) 22 (23.2) .453† 74 (81.3) 73 (76.8) Mean age, y 42.2 ± 14.8 42.0 ± 14.0 .9372 Mean body mass index, kg/m2 23.9 ± 2.9 23.6 ± 2.8 .4962 *Chi-Square test † t test Table 4. Comparing the quality of plain images in prepared and unprepared subjects considering their bowel habit patterns. Number of patients Visualization score P Image quality based on European Commission Guidelines P Patients with constipation Group 1 Group 2 17 11.53 ± 2.40 .001 3.47 ± 0.87 .005 22 8.81 ± 2.32 2.54 ± 0.80 Patients with normal bowel habits Group 1 Group 2 74 12.04 ± 1.91 .253 3.60 ± 0.66 .101 73 12.36 ± 1.62 3.70 ± 0.62 604 | - - - anatomical section in control images, Guo and associates noted a higher visualization score of the right renal region visualization score of the right renal region on the control image. - including polyethylene glycol, dietary restriction, and no preparation at all. They noted an equal amount of gas in the - (9) Dehydration has been considered to provide greater concen- tration of contrast and better visualization of the collecting system.(15) (16) (17-19) - and noted that active hydration may even produce a diagnos- tic quality urogram.(19) - cially in diabetic patients.(20,21) - ologists (2005) does state that dehydration prior to contrast contrast-induced nephropathy.(22) may suffer from constipation due to medication or immobil- ity. chronic constipation has not been evaluated previously. To has been evaluated in patients suffering from functional con- stipation. CONCLUSION from historical reports and do not seem to be evidence-based practices. Type and amount of contrast agents, the radiographic equipments, and the availability of tomography also affect the - trast, the larger volumes used, and advances in radiographic equipment and technique, the routine use of catharsis and di- - Table 5. Comparing the quality of contrast images in prepared and unprepared subjects considering their bowel habit patterns. Number of patients Visualization score P Image quality based on European Commission Guidelines P Patients with constipation Group 1 Group 2 8 13.00 ± 1.31 .694 4.38 ± 0.52 .463 7 12.71 ± 1.25 4.14 ± 0.38 Patients with normal bowel habits Group 1 Group 2 35 13.26 ± 1.31 .282 4.29 ± 0.46 .443 27 12.93 ± 1.17 4.37 ± 0.56 Miscellaneous 605Vol. 9 | No. 3 | Summer 2012 |U R O LO G Y J O U R N A L CONFLICT OF INTEREST None declared. REFERENCES 1. Roberge-Wade AP, Hosking DH, MacEwan DW, Ramsey EW. The excretory urogram bowel preparation--is it necessary? J Urol. 1988;140:1473-4. 2. Bailey SR, Tyrrell PN, Hale M. A trial to assess the effective- ness of bowel preparation prior to intravenous urography. Clin Radiol. 1991;44:335-7. 3. George CD, Vinnicombe SJ, Balkissoon AR, Heron CW. Bowel preparation before intravenous urography: is it necessary? Br J Radiol. 1993;66:17-9. 4. 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