Intravenous Urography - Indications, Contraindications, Procedure, and Complications

What Is Intravenous Urography?

The urinary system comprises organs that work to filter the blood, form urine, and maintain the fluid and electrolyte levels of the body. Kidneys, ureters, urinary bladder, and urethra are the important organs of the urinary system. The urinary tract contains immune cells that protect it from infections and diseases. However, certain conditions cause the failure of the urinary tract and need to be diagnosed and treated on time. There are several diagnostic methods available, but imaging tests prove to be the most accurate. Intravenous urography is one of the imaging tests that help to detect the problems of the kidneys, ureters, and urinary bladder. A contrast material is injected into the body through the veins to examine the urinary tract organs. The X-rays images obtained after the procedure are known as intravenous urogram or intravenous pyelogram.

Why Is Intravenous Urography Done?

Intravenous urography helps to examine the kidneys, urinary bladder, and ureters. It gives the doctor an idea about the size and shape of these organs and detects the presence of abnormalities. The intravenous urography is done to diagnose the following conditions:

• Kidney Stones - Nephrolithiasis or kidney stones form when the minerals and salts present in the urine clump together and form masses. These stones might travel the ureters from the kidneys and obstruct them. As a result, the urine flow also gets restricted. Intravenous urography helps to locate the stones so that they can be removed easily.

• Bladder Stones - Bladder stones form when the patient is unable to empty the bladder. As a result, the urine remains in the bladder resulting in the crystallization of the salts and minerals present in the urine. Intravenous pyelography helps to detect the causes of bladder stones so that the treatment can proceed accordingly.

• Enlarged Prostate Gland - The prostate gland is located near the neck of the urinary bladder in males. If the gland becomes enlarged, the bladder might get obstructed, and the urine flow is restricted. The causes of prostate gland enlargement can only be detected by imaging tests.

• Hematuria - Hematuria, or the presence of blood in the urine, is a common symptom of a variety of urinary tract diseases. Intravenous urography helps to know the exact disease of the urinary system that might be causing hematuria.

• Kidney Cysts - The presence of multiple fluid-filled sac-like structures or cysts form on the kidneys and interfere with their functions. The doctor recommends intravenous urography to get an idea about the size of the kidneys. It is because the kidneys become enlarged due to cysts.

• Medullary Sponge Kidney - It is a rare condition in which cysts form in the kidney tubules. The urine flow becomes restricted as these cysts block the ureters (the tubes that carry urine from the kidneys to the bladder). This condition is present by birth, so it can be easily diagnosed by intravenous urography.

• Ureteropelvic Junction Obstruction - The meeting point of the kidneys and the ureters is known as the ureteropelvic junction. It is the point at which the kidneys drain the urine into the ureters. Intravenous urography helps to know about the location and the nature of the obstruction so that it can be treated and the normal urine is restored.

What Are the Contraindications of Intravenous Urography?

There are no absolute contraindications of intravenous urography. However, the patient must not undergo the procedure under the following conditions:

1. Iodine Allergy - Intravenous urography uses an iodine-based dye to produce images of the internal organs. Some people are allergic to iodine, and an anaphylactic reaction can occur if the dye is administered to such patients. Anaphylaxis is one of the most severe forms of allergic reaction and is a medical emergency. The patient might not show any symptoms during the procedure, but if the dye flows under high pressure, an allergic reaction will surely occur. As the dye is injected into the veins, it gets absorbed in large amounts in the body.

2. Kidney Disease - If a person is suffering from kidney disease or urinary tract infections, the procedure should not be done. It is because the risk of sepsis and kidney failure increases. After all, the kidneys are unable to filter the dye.

3. Pregnancy - The procedure should be avoided or done carefully in pregnant females. It is because a higher dose of radiation harms the growing fetus and causes severe complications.

How Does the Patient Prepare for Intravenous Urography?

The following things need to be kept in mind before the procedure:

1. The doctor explains the procedure, the benefits, and the side effects associated with it. If the patient is willing to undergo the same, he needs to sign a consent form.

2. The patient should also inform the doctor about the medications he is taking or any allergies or disorders he is suffering from. For example, the doctor might ask to stop taking drugs like Aspirin and Ibuprofen before the surgery, as they can cause excessive bleeding.

3. The doctor might recommend the patient undergo a blood test to check the general health of the body.

4. Diabetic patients need to stop taking Metformin before the procedure. It is because Metformin gets combined with the contrast medium and affects the kidneys.

5. The patient needs to inform the doctor if he is allergic to the contrast medium or the dye so that the procedure can be carried out by taking the required precautions.

6. A laxative is usually given before the procedure to allow bowel movement. It helps the patient to pass stools so that the bowel is clean. The medication can be injected through the rectum to facilitate bowel movement, known as an enema.

7. The patient should not eat anything the night before the surgery and only take his prescribed medication in the morning before coming for the procedure.

What Happens During the Procedure?

The intravenous urography can be done at the hospital or the radiology center. The steps of the procedure have been listed below:

• First, the patient needs to remove the ornaments and clothing that might interfere with the test.

• The patient is placed in a position where he lies on the back, and his legs are placed in the stirrups.

• The vitals like blood pressure, pulse rate, and body temperature are checked before the procedure.

• An intravenous line is attached to the arm of the patient to administer the dye or the contrast material.

• The machine is positioned over the abdomen to take the X-rays of the urinary system before the dye is injected.

• Next, the dye is injected through the intravenous line, and the X-rays are taken at regular intervals as the dye flows through the body.

• The patient might feel a weird taste in the mouth and have a headache as the dye flows in the body, but that will subside after some time.

• After the X-rays are taken, the patient is asked to urinate and come back again to the X-ray table.

• Finally, the X-rays are taken to see how much dye remains in the urinary system after urinating.

What Happens After the Procedure?

After the procedure is complete, the patient is taken to the recovery room to monitor the blood pressure, pulse, and respiratory rate until they become normal. Once they are normal, the patient is sent back home. The patient might experience nausea, headache, itching, and a metallic taste in the mouth for a few days, but that is normal and will subside after taking medications. Keep a record of the number of fluids consumed each day and the urine passed. Also, the patient is asked to drink plenty of water daily to flush out the remaining dye. Consult the doctor immediately if the following symptoms are noted:

1. Fever.

2. Swelling or bleeding from the urinary tract.

3. Presence of a large amount of blood in the urine.

4. Severe pain near the urinary opening.

5. Difficulty in passing urine.

6. Skin irritation, hives, and sneezing.

What Are the Complications of the Procedure?

Intravenous urography does not cause any serious complications as it is a simple procedure. However, allergic reactions are commonly seen when the dye flows through the body. The allergic reactions can be mild, moderate, and severe. They have been described below:

• Mild allergic reactions mainly include itching, irritation, and swelling at the intravenous site. The person sneezes continuously due to the scratchy throat. Eye infection or conjunctivitis is commonly seen in some patients.

• Moderate reactions include the spread of inflammation and redness from the intravenous site to the face, lungs, and throat. As a result, swelling of the face, shortness of breath, and sore throat are commonly seen.

• One of the most severe forms of allergic reaction is anaphylaxis. It is a life-threatening condition wherein the patient goes into a state of anaphylactic shock due to reduced blood pressure. Vomiting, diarrhea, and respiratory difficulties occur commonly. It is a medical emergency, and the patient requires intensive care and attention.

Conclusion:

Intravenous urography is an imaging procedure that helps to detect problems in the urinary tract. A contrast material or a dye is injected into the body through the veins. The X-rays are taken at regular intervals as the dye flows through the body. The advantage of the procedure is that the contrast medium blocks the X-rays, so the images are clear as compared to the normal X-rays. The kidneys, ureters, and the urinary bladder appear white on the X-rays due to the dye. The test is used to detect stones, tumors, ureteral strictures, and the causes of ureteropelvic junction obstruction. The patients allergic to the iodine-based dye might develop allergic reactions in the body, but that happens rarely. The patient must understand the procedure, the benefits, and the risks associated before undergoing the procedure. If the person is allergic or had allergic reactions before, alternative imaging tests must be recommended.