Background: Urolithiasis affects 5-15% of the population, with 70% of suffers between the ages 18 and 50. Guidelines detail Intravenous Urography (IVU) as the 'gold standard' for diagnosis; however advances in Computed Tomography Urography (CTU) have led to adoption of this alternative test. The radiation risks from CTU have not been widely reported. Objectives: To compare IVU and CTU for diagnostic accuracy and radiation risk. Consideration criteria: Prospective, randomised control trials, diagnostic accuracy and adverse effects studies comparing IVU and CTU accuracy and/or radiation dose were included. Participants were adults with confirmed or suspected urolithiasis. Search strategy: A search of the databases; AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE and Science Direct, was conducted between 1995 and week 40, 2009. Secondary searches of reference lists and main subject journals were completed. Methods of review: A systematic review method was employed using '. a priori' standardised forms, by two independent reviewers, to select studies, assess quality and extract data. Results: Ten studies from 283 potential references met the inclusion criteria. Diagnostic accuracy results showed consensus that CTU provides better sensitivity with comparable specificity to IVU. Dose results showed CTU to be associated with greater dose and risk of cancer than IVU. Conclusion: Decisions regarding which test should be used for urolithiasis should be taken with regard to their age and associated risk from ionising radiation. IVU represents a specific and low dose method of assessment.