IS BOWEL PREPARATION FOR EXCRETORY UROGRAPHY NECESSARY?

Abstract

Objective: The objective of this study was to compare the three methods of preparation for excretory urography with regards to image clarity: bowel preparation, together with dietary restriction, dietary restriction alone and
no preparation at all.
Study Design: Randomized control trail.
Place and Duration of Study: Department of Radiology, Military Hospital, Rawalpindi, which is a tertiary care hospital. The duration of study was 6 months from Aug 2009 to Feb 2010.
Material and Methods: This was a randomized control trial of 588 patients undergoing excretory urography at a tertiary care hospital. Both male and female consecutive ambulatory patients older than 15 years referred for excretory urography were included in the study. The 588 patients were randomly distributed into three separate groups. Group 1 received standard bowel preparation consisting of tablet bisacodyl in a dose of 30 mg. The patients were instructed to fast for 4 hours before starting the laxative and do drink the laxative drug in theafternoon the day before the examination. Group 2 was instructed to only fast for 12 hours before the examination and the group 3 received no preparation at all. All the three groups were advised not to take breakfast and underwent the same examination procedure and then image clarity was assessed. The images were shown to a single consultant who was blind about the group of the patient and bowel preparatory technique which he or she underwent. Images were regarded clear when pelvicalyceal system, ureters and urinary bladder were demonstrated beyond any doubt. Same contrast agent (urografin) was used in all the three groups in a dose according to body weight (1 mg/kg) to exclude its effects on image clarity.
Results: Assessment of image clarity was done between group 1 and 2, group 1 and 3 and group 2 and 3. The image clarity in patients of group 1 patients was found to be 94.3% and images were unclear in 5.7%. The image clarity in patients of group 2 was found to be 95.4% and the images were unclear in 4.3%. The image clarity in patients of group 3 was found to be 95.1% and images were unclear in 4.9%.
Conclusion: Bowel preparation before excretory urography does not effect the image clarity and should be abandoned.