Intravenous Pyelogram - Uses, Preparation, Procedure, Interpretation, and Risks

Introduction:

Intravenous pyelogram (IVP), also called intravenous urography or excretory urogram, is a type of X-ray using contrast material to provide images of the urinary tract. The urinary tract is made of kidneys, bladder, and ureters (narrow tubes carry urine from the kidneys to the bladder).

What Are the Uses of Intravenous Pyelograms?

An intravenous pyelogram is used to detect urinary tract disorders and to assess the size, shape, and efficiency of the urinary tract. IVP may be useful in the diagnosis of the following conditions:

• Kidney stones.

• Kidney cysts.

• Bladder stones.

• Enlarged prostate.

• Urinary tract tumors.

• Structural kidney disorders such as medullary sponge kidney (a birth defect in which changes occur in tiny tubes of fetus kidneys).

You may be asked to take an intravenous pyelogram when you are having the following symptoms as it may be related to urinary tract disorder.

• Hematuria (blood in the urine).

• Pain in the side and lower back.

• Cloudy urine.

• Fever.

• Swelling in your feet and legs.

• Pain while urinating.

How Do You Prepare for Your Intravenous Pyelogram Procedure?

• You should not eat or drink after midnight on the night before the procedure.

• You may be asked to take mild laxatives (medicine that increases stool motility) on the evening before the test.

• You may need a blood test to see how well your kidneys react to the dye.

• You may be given a cleansing enema (injection into the rectum stimulates bowel movements) a few hours before the test.

What Are the Factors To Be Considered Before the Intravenous Pyelogram Procedure?

• Pregnancy (radiation exposure may affect the fetus in the womb).

• Allergic to contrast materials.

• Allergic to latex, tapes, anesthesia, or any other medicines.

• Inform your health provider about your medical conditions and your regular medicines, including herbal supplements.

• Tell your health provider if you are taking antiplatelet drugs (drugs that decrease platelet aggregation) or blood thinners.

• Inform your health provider if you are having kidney failure or disorders, as the contrast material used in the procedure may worsen your condition.

• Inform them if you have diabetes, asthma, or congestive heart failure.

How Is an Intravenous Pyelogram Performed?

• Before the procedure, you were asked to remove your clothes and wear the gown given by your health provider.

• You may be asked to lie faceup on the X-ray table. A set of images [kidney, ureter, and bladder (KUB) radiograph] is necessary before injecting the special dye.

• After that, they will inject a special dye called contrast material into the vein in your arm through an intravenous (IV) line. The contrast material (iodine-based) passes through your bloodstream into your kidneys and urinary tract. Your technician may wrap a special belt tightly around your stomach, which helps the dye to stay in the urinary tract while imaging.

• After one to three minutes of dye injection, your technician may take a series of X-rays. These X-rays are converted into video images (fluoroscopy) that will be visible on the computer screen.

• You may be asked to change your body position and hold your breath for a few seconds to get clear images during the procedure. The contrast material will appear bright white on the X-ray.

• IVP shows the kidney begins to empty into the uterus.

• During imaging, if the special dye moves too slowly or does not move, it shows the location of the block. Oblique radiographs help in detecting the position and nature of calcifications(collection of calcium salts appears as stones).

• Finally, you may be asked to empty your bladder to get a clear picture of the bladder.

It takes less than an hour for this procedure. When your kidneys function too slowly, it may take up to four hours. After the test, X-rays are stored as digital images which are easily accessible and may be compared with previous X-rays for diagnosis after your test.

What Are the Instructions Given After an Intravenous Pyelogram?

You do not need any special care after the intravenous pyelogram procedure. You can continue your regular activities and have a regular diet. You may be instructed to drink plenty of water to flush out the contrast materials from your body. Inform your doctor if you are facing any difficulties after the procedure, such as fever, nausea, blood in the urine, or redness/bleeding/drainage from the injection site.

What Are the Interpretations of Intravenous Pyelogram?

Normal Interpretations:

• The average length of the kidney ranges from 9 to 13 centimeters.

• The vertical axis of the kidney is parallel to the same side upper third of the psoas major.

• The upper pole of the kidney is usually at the level of the 12th rib.

• The upper pole of the left kidney is slightly higher than the right kidney.

Abnormal Interpretations:

• Ureterocele (swelling at the bottom of the ureter) may appear as a cobra head or spring onions sign (dilatation of the distal ureter surrounded by a thin lucent line) in IVP.

• Tuberculosis of the urinary tract may produce remarkable signs on pyelograms, such as the sawtooth ureter (mucosal irregularity) or pipestem ureter.

• If the distance between the ureters seems to be less than 5 cm, it is considered a medial deviation of the ureter. If the ureter is 1 cm outside the tip of the transverse process of the vertebrae, it will be considered a lateral deviation of the ureter.

• The formation of the phantom calyx (lack of contrast opacification of calyx [a part of the kidney] can appear in benign and malignant neoplasms(cancer).

• In renal cell carcinoma (kidney cancer), the papillae may appear aberrant (abnormal).

• Loss of papillary impression and clubbing of calyces in chronic obstruction.

• Outpouchings of contrast material can result from diverticula(bulging pouches).

What Are the Risks of Intravenous Pyelogram Procedures?

IVP is mostly a safe procedure. Some of the side effects include:

• Nausea.

• Headache.

• Metallic taste in your mouth.

• You may feel itchy as the dye passes through your body.

• Common allergic reactions to contrast material such as itching and hives(skin rash).

• Serious reaction to contrast materials such as low blood pressure, shortness of breath, and cardiac arrest.

What Are the Factors Affecting the IVP Test?

• Presence of stool or gas in your colon.

• Poor blood flow to the kidneys.

• Barium (a liquid you swallow that helps to see your upper gastrointestinal tract) in your intestines from your recent barium swallow study.

Conclusion:

An intravenous pyelogram (IVP) provides clear and detailed images that allow the doctor to detect urinary tract abnormalities at an earlier stage which can be treated with medicines. This procedure can avoid the need for invasive surgical procedures. The radiation exposure in IVP is very minimal. It is a minimally invasive diagnostic procedure.