ABSTRACT
Background: Retrograde pyelograms (RPG's) are a key component of numerous endoscopic urological procedures. They provide a vital role in defining anatomy of the urological tract and assessing structural and functional obstruction of upper tracts. Method(s): Retrospective review of Medicare data published for item number 36818 cystoscopy and ureteric catheterisation guided by fluoroscopic imaging. We also considered item number for endoscopic insertion of ureteric stent (36821). Data collected over 10 year period from 2012 to 2021 inclusive. State population data collected from Australian Bureau of Statistics to calculate the rates per 100 000 people. Result(s): The nationwide median rate of RPG for the period 2012-2021 was 104.2 per 100 000 (interquartile range 100.6-112.9). The rate between states varied widely (Table 1). NSW and Tasmania consistently recorded higher than average RPG uptake across the study period. Queensland, WA, ACT and NT all reported lower than average RPG usage. All states reported a sharp downturn in numbers during 2021 presumably due to the coronavirus pandemic. For ureteric stent insertion, NSW and Tasmania were above average, while Queensland, WA, ACT and NT were consistently below average. Conclusion(s): Use of retrograde pyelogram is variable according to geography, the reasons for which are unclear. Practice patterns, patient demographics and financial considerations are all likely to be contributors. Future research is encouraged to assess the basis for this variation, but also considering use of other imaging (CT intravenous pyelography) and patient factors (e.g. renal disease).