A 47-year-old client comes to the emergency department complaining of moderate flank, abdominal, and testicular pain with nausea of 4 hours’…

An intravenous pyelogram (IVP), also known as an excretory urogram, is a comprehensive diagnostic study that uses contrast dye to visualize the entire urinary tract. It can precisely locate a calculus within the kidney, ureter, or bladder. Crucially, it also provides functional information by demonstrating the degree of obstruction, which is indicated by delayed excretion of the dye and dilation of the urinary tract (hydronephrosis). This combination of anatomical and functional detail makes it the best diagnostic study among the choices to confirm the physician's suspicion of an obstructing stone.

A. Cystoscopy: This procedure is primarily for visualizing the bladder and urethra and is not the initial diagnostic tool for stones located higher in the ureters.

B. Kidneys, ureter, bladder, x-ray of abdomen: A KUB x-ray can miss radiolucent stones (e.g., uric acid stones) and provides no information on renal function or the degree of obstruction.

D. Ureterolithotomy: This is a surgical treatment to remove a stone from the ureter, not a diagnostic procedure to confirm its presence.

1. Hall, P. M. (2009). Nephrolithiasis: treatment, causes, and prevention. Cleveland Clinic Journal of Medicine, 76(10), 583–591. In the section "Diagnostic Evaluation" (p. 585), the article states that an intravenous pyelogram can "confirm the diagnosis and reveal the location of the stone and the degree of obstruction." https://doi.org/10.3949/ccjm.76a.09043

2. University of Virginia School of Medicine, Department of Radiology and Medical Imaging. (n.d.). Genitourinary Radiology Curriculum: Urolithiasis. Retrieved from https://www.med-ed.virginia.edu/courses/rad/gu/urolithiasis.html. In the section on "Intravenous Urogram (IVU)," the courseware notes that an IVU "provides both anatomic and functional information" and is excellent for "demonstrating the collecting systems, ureters, and bladder" and showing "the degree of obstruction."

3. Curhan, G. C., & Aronson, M. D. (2023). Diagnosis and acute management of suspected nephrolithiasis in adults. In UpToDate. Retrieved from Wolters Kluwer. (Accessed via institutional access). The section "Choice of imaging study" discusses that while noncontrast CT is now the preferred modality, intravenous pyelography (IVP) was the prior standard because it can "establish the diagnosis of a stone, determine its size and location, and assess the degree of obstruction."