“Much Ado About Nothing”

894

LETTERS TO THE EDITOR

credit to Winchell and Arata for devising infusion urography. As is true with so many innovations in medicine, others, known only to themselves, probably employed a similar procedure long before, and so forth and so forth .... 1. Treves, S., Adelstein, S. J. and Mcllmoyle, G.: Radionuclides. In: Campbell's Urology, 4th ed. Edited by J. H. Harrison, R. F. Gittes, A. D. Perlmutter, T. A. Stamey and P. C. Walsh. Philadelphia: W. B. Saunders Co., vol. 1, chapt. 7, pp. 270-277, 1978. 2. Weiss, R. M.: Clinical implications ofureteral physiology. J. Urol., 121: 401, 1979. 3. Buck A. C., Macleod, M.A. and Blacklock, N. J.: The advantages of iismTc DTPA(Sn) in dynamic renal scintigraphy and measurement of renal function. Brit. J. Urol., 52: 174, 1980. 4. Whitesel, J. A. and Heller, E.: Intensification of the excretory urogram by continuous infusion of contrast material. J. Urol., 92: 224, 1964. 5. Schencker, B.: Drip infusion pyelography. Indications and applications in urologic roentgen diagnosis. Radiology, 83: 12, 1964. 6. Malave, S. R., Neiman, H. L., Spies, S. M., Cisternino, S. J. and Adamo, G.: Diagnosis of hydronephrosis: comparison of radionuclide scanning and sonography. Amer. J. Roentgen., 135: 1179, 1980. 7. Perlow, D. L.: The use of progesterone for ureteral stones: a preliminary report. J. Urol., 124: 715, 1980. "MUCH ADO ABOUT NOTHING"

Note by Editor. In response to my note following the Letter to the Editor by Pollack and Banner in the October issue of the Journal of Urology, page 576, the following letters have been received. They are printed in order of their receipt. Since the vote was 3 for IVP, 3 for IVU, 1 for EX U and 1 for XU, the Journal policy will remain the same, that is we will continue to use IVP for excretory urogram. To the Editor. I disagree with the comment in regard to use of the abbreviation IVP. The use of this abbreviation is well recognized in all areas of urology, including the English language and 59 foreign languages. Respectfully, Fletcher Derrick, Jr. 216 Calhoun Street Charleston, South Carolina 29401

To the Editor. I believe that the abbreviation IVU is as bad as IVP and would prefer the term excretory urogram. Some people abbreviate this EX U, as a simplication. If we are considering a change then we should improve upon the old product and not simply rearrange it. Respectfully, A. Barry Belman Department of Pediatric Urology Children's Hospital National Medical Center Washington, D. C. 20010

To the Editor. Up with IVU, down with IVP. Respectfully, Ralph Landes Danville Urologic Clinic 1040 Main Street Danville, Virginia 24541

To the Editor. What is the real difference in the abbreviations IVP and IVU? Of what great import is such a change? I see no great harm in using IVP, especially since most of us were brought up on it and Valentine's flask still exists today. Trying to change IVP to IVU, in my opinion, is like saying "The glass of water is 'half empty' and the other side responds, 'No it is half full'." It is a little bit of a radiological absurdity-nomenclature wise. Respectfully, Harry Bergman 4200 Hillcrest Drive #219 Hollywood, Florida 33021

To the Editor. In the October 1980 issue of the Journal the term excretory urogram (IVP) was used in 11 of 44 articles (25 per cent). In the same issue 17 different abbreviations were used, excluding abbreviations for units, compounds, hormones, word shorteners, symbols and descriptive terms too many times to be counted.

In this modern era of computers and acronyms scientific shorthand, whether by symbols or abbreviations, is absolutely necessary as long as confusion is avoided by standardization and acceptance of such symbols and abbreviations. The descriptive ambiguity of intravenous pyelogram (IVP) and excretory urogram (IVP) should be resolved and appropriate abbreviations should be chosen. Today, the terminology intravenous pyelogram (IVP) has been widely replaced with the terms excretion urogram, excretory urogram and intravenous-i.,.rogram. The obvious reasons are that with modern contrast media and modern techniques of radiology the entire urinary tract, that is intraluminal structures and related soft tissues, is visualized, not just the renal pelvis, calices and infundibula. Perhaps an understanding of the distinctions of this terminology can be obtained from the original Greek terms: "pyel" means trough-namely, the intraluminal structures (pelvis, calices and infundibula), while "uro" means urine. Surely, "uro", referring to all structures in contact with urine, should be preferred to "pyel", for these reasons, and because the comprehensive term urogram is already in common usage. In addition, a choice of the preferable adjective, intravenous or excretory should be made. In the former instance, one is describing the method of administration of the procedure (a perfectly acceptable way to describe a medical procedure of which there are many similar examples, that is inhalation anesthesia), while in the latter instance one is describing a physiologic process by which the study attains its objectives (a lesser acceptable and more controversial way to describe a medical procedure). On balance, therefore, it appears that the term intravenous is preferable. Thus, please accept my vote for intravenous urogram and the abbreviation IVU. Respectfully, E. Douglas Whitehead 785 Park Avenue New York, New York 10021

To the Editor. During the last few years I have been fighting a losing battle in trying to introduce the abbreviation IVU as opposed to the more traditional IVP. I received many phone calls from nurses questioning the orders for IVU. I continued to use the term IVU and decided not to give up. In the meantime, I found a worthwhile compromise. Whenever I order an IVU I add in parenthesis (IVP). I hope that in a few years I may still be able to influence and educate the nursing staff of the hospital. Respectfully, Hans E. Schapira Department of Urology Mount Sinai Hospital New York, New York 10029

To the Editor. The letter concerning standard usage of the abbreviation IVP is pertinent and timely. The bright young men at the University of Colorado Medical Center (and probably many other centers of learning) refer to the IVP as the XU (excretory urography). This terminology is much more exact and appropriate. I would encourage its use. Respectfully, John A. Whitesel Rocky Mountain Urology, P. C. 2020 Wadsworth Boulevard Lakewood, Colorado 80215

To the Editor. Although these investigators voiced their objections to the current use of the abbreviation IVP to designate intravenous urography they offer a remarkably similar abbreviation, IVU, in its stead. While their view might be endorsed by strict lexicographers the general medical community would be less enthusiastic. Webster's Dictionary defines language as "words ... understood by a considerable community; a systematic means of communicating; the vocabulary and phraseology belonging to an art or department of knowledge." I submit that IVP fulfills these criteria in every respect. In an age in which abbreviations assault the reader in every sentence one that is recognized quickly and understood should be preserved. Respectfully, W. J. Ferguson Department of Urology Naval Regional Medical Center San Diego, California 92134