Intravenous Urography (IVU)

 Intravenous Urography(IVU)

It is a radiographic study of the renal parenchyma pelvic system ureters and the urinary bladder with the help of intravenous radio-opaque contrast material or dyes the other names of the study are

intravenous pyelography(IVP) and excretory urography the indications of the study are the evaluation of renal function hematuria ureteric colic recurrent urinary tract infections suspected urinary tract pathology or any congenital anomaly suspected urinary tract injury there are also some contraindications to the study and these have been divided into absolute and relative contraindications the absolute.

Contraindications are the history of any contrast allergy and renal failure while the relative contraindications include hepatorenal syndrome thyrotoxicosis pregnancy and multiple myeloma

 The procedure of carrying out intravenous urography the equipment needed for the study is a basic x-ray or fluoroscopy equipment plus a radiographic contrast material or tie it is usually an iodinated contrast material and the two most commonly used materials are autographing which is a high osmolarity contrast material and iohoxol or low osmolarity contrast material low osmolality contrast materials are usually preferred nowadays these have fewer chances of adverse reactions or contrast allergy than the high osmolarity group coming to the patient preparation history is very important especially the history of any contrast allergy in the past and history of any systemic illness like diabetes multiple myeloma and thyrotoxicosis the patient has to be fasting for at least four to six hours but remember do not dehydrate the patient bowel preparation is very important as

we do not want bowel gases to obscure some important findings the serum creatinine levels of the patient should be within the normal limits usually less than 1.5 milligrams per deciliter the

The technique of performing ivu is a three-fold one it involves a preliminary plane x-ray film or the kub the injection of radiographic contrast material and lastly taking sequential x-rays of the kub region the preliminary film or the control film is also known as the kub is an anterior-posterior radiograph of the kidney ureters and bladder region it is performed prior to the administration of radiographic contrast material the next step is the injection of radiographic contrast material test doses were given in earlier times however nowadays these have been discontinued

Because the risk of adverse reaction is independent of the dose given the usual dose is one milliliter per kg body weight the last step is taking sequential x-rays of the kuv region after the administration of contrast material so multiple films are taken starting with a one minute film also known as a nephrogram phase then a five-minute film than a 10 to 30-minute film known as the ureterogram phase a full bladder film is also known as cystogram phase which is usually taken at around 45 minutes or when the patient complains of a full bladder and lastly, post widening film these are the basic radiographic films taken after the administration of contrast material, however, additional films can be taken or a modification of procedure can be done depending on the indication and the

patient now let's discuss each of these films one by one the immediate film or the nephrogram phase is an anterior-posterior or ap view of the renal areas to show the nephrogram that is opacification of the renal parenchyma in this film, we should look for the size outline axis and the position of both the kidneys as you can see in this film there is paint or pacification of both the kidneys

the next film is taken discretely

the phase is around 5 to 15 minutes and in this film, we look for the contour of both kidneys we look at whether the contrast is filling both the pelvic Alicia system or not and we look for any delayed film or absent filling the next film is taken at around 30 minutes it is known as a ureterogram phase-in this we look for any dilatation of collecting system or ureters and the evidence of any filling defect within the collecting system or ureters the whole ureter is very often not entirely demonstrated in one single film because of the peristaltic wave so we may have to look for other films as well the next film is taken when the patient complains of the full bladder that is usually around 40 to 45 minutes after the injection of contrast material look for bladder size and shape look whether the contrast is filling the bladder or not look for the bladder surface whether it is smooth or irregular and also look for any diver to kill a

filling defect or prostate indentation in this film

lastly, a post widening film is taken

in which we look for any residual urine

as shown by the arrow in this film

and also look whether any contrast is

left in the upper

the urinary tract which can be because of

reflux

or because of delayed excretion now