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The optimal radiopaque agent for excretory urography. Excretory urography of the kidneys, ureters and urinary bladder

Urography is a safe diagnostic procedure for the body. The research technique is used if there is a suspicion of progression of diseases of the renal system or urinary tract, and urography is also used if there are disturbances in urine filtration. The diagnostic procedure allows you to identify stones, neoplasms of a malignant or benign nature, and determine the structure of the paired organ.

The technique is highly informative and allows us to identify most possible pathologies of the renal and urinary systems.

Urography is a type of radiographic examination that allows one to identify disturbances in the functioning of vital systems of the human body. To obtain more information, a contrast agent is used, after injection of which radiography is prescribed.

When performing an overview diagnostic technique, contrast is not used. Intravenous urography is permitted for patients of all age categories. During the study there were no complications, discomfort or pain.

Doctors highlight several positive aspects of urography:

Provides accurate information about damage to the renal organ, allows you to identify the stage of development of the disease.
X-rays show the structure and parenchyma; it is possible to examine the calyces and pelvis of the renal system.
Allows you to determine the efficiency of the paired organ.
During execution it is not accompanied by painful sensations for the patient.
Tissues are not injured as a result of the research technique.
Allows you to identify most diseases, including those of a congenital nature.
Foci of the inflammatory process are easily identified.
The diagnostic technique is used for both adult patients and elderly patients and children.
Several types of urography allow the doctor to select the appropriate type for a more detailed diagnosis in an individual case.
Preparing the patient for the procedure does not require the use of expensive medications.
During the research, exposure to the body is minimal.

Urography allows you to obtain reliable data on the condition of the organs of the renal and urinary systems.

When to use

X-ray of the renal system is used if there is suspicion of the development of the following pathological syndromes:

Presence in the renal system.
The appearance of neoplasms of a benign or malignant type.
Progression as well.
With the development of hypertension, the provoking factor of which is a disease of the renal system.
A diagnostic procedure is used to determine the causative factor of hematuria.
When diagnosing congenital pathological syndromes associated with the structure of the renal or urinary systems.
Infectious diseases developing in the urinary system.
If there are disturbances in the tissue structure.
To control affected areas during the development of renal colic.

Also, the diagnostic procedure is used to clarify the condition of the organs of the renal or urinary systems after surgical treatment.

Possible contraindications

The research technique is not suitable for all patients suffering from pathological syndromes of the kidneys or genitourinary system. Before performing a diagnostic procedure, the doctor finds out whether there are any contraindications for the patient being examined. The patient should notify the specialist about all existing chronic pathologies, as well as the presence of an allergic reaction or pregnancy.

Conducting research is unacceptable in the following situations:

Chronic kidney failure or acute stage.
Increased likelihood of bleeding.
Thyroid diseases.
Low blood clotting, progression of pheochromocytoma.
The final stages of development of pathologies of the liver or paired organ.
Medicines like Glucophage when undergoing treatment for diabetes.
Negative reaction of the immune system to iodine or other components of the contrast agent.
Presence of bleeding at the time of the diagnostic procedure.
Breastfeeding a child.

If there are contraindications for kidney urography, magnetic resonance imaging is an alternative option. The patient may also be prescribed a computed tomography or ultrasound examination of the renal and urinary systems. These diagnostic procedures allow you to obtain reliable data, but the degree of information content, in comparison with urography, is lower.

Types of urography

X-rays of the urinary tract and paired organs are performed using a variety of techniques. The type of diagnostic procedure is determined by the doctor. The choice depends on the nature of the pathological syndrome, the degree of development, and the expected functionality of the renal system. The survey nature of urography is used before the contrast type of radiographic examination. The latter is used to obtain a detailed clinical picture of the internal elements of the kidneys.

Overview

The peculiarities of this type of research technique include the absence of injection of a contrast agent. The diagnostic procedure allows you to identify the presence of stones and other foreign bodies in the area under study, detect malignant or benign neoplasms, and identify the progression of infectious diseases.

Survey urography provides a general picture of pathological syndromes. Makes it possible to determine the condition of the paired organ, as well as the beginning of the urinary canal. X-ray images show the patient’s bone structures, their shape and location; if all recommendations for implementation are followed, the shadows of the paired organ and elements of the urinary system are clearly visible.

excretory

Doctors highlight the following features of this type of diagnostic procedure:

X-rays are taken when contrast is removed from the body.
The research technique determines the degree of efficiency of the urinary tract and the speed at which the patient’s bladder fills.
During the diagnostic process, it is possible to detect stones, identify their location, and determine their size and shape.
The excretory nature of the research technique is used to diagnose cysts and neoplasms in the renal system.

Also, urography of this type allows you to evaluate the structure of the elements of the genitourinary system.

Contrasting

This type of research methodology is characterized by the following features:

An iodine-containing contrast agent is administered intravenously to the patient.
The essence of the diagnostic procedure lies in the ability of the renal system to filter and remove processed substances, including during metabolism.
To carry out a contrast type of urography, Visipak, Cardiotrast and similar drugs are used.
After the injection, a characteristic clinical sign is a feeling of heat, as well as the appearance of a metallic taste in the mouth. Another side effect is nausea and a burning sensation at the site where the contrast agent was injected. The above symptoms disappear on their own within 5-10 minutes.
Before performing the diagnostic procedure, you should empty your bladder. X-rays are taken when contrast material accumulates in the blood. Initially, the image is taken 2 minutes after administration of the drug, then the interval is 5 minutes.

A contrast diagnostic procedure shows the condition of the pyelocaliceal system, a paired organ, and allows you to diagnose the inflammatory process of the prostate gland. On the obtained X-ray images, it is possible to diagnose hyperplasia and hydronephrosis, and pathological changes are determined, in particular, stretching in the urethral tract.

Retrograde

Retrograde urography has an alternative name - ascending. It is characterized by the introduction of a contrast agent into the urethral system. Allows you to assess the performance of the ureters. The unilateral nature of catheterization is used, since bilateral is accompanied by a large number of side effects.

CT urography

It is one of the varieties of excretory diagnostic techniques. However, a computed tomograph is used instead of X-rays. CT urography is a combined research technique.

The contrast agent is administered intravenously; in rare cases, a dropper is used. During the diagnostic procedure, the patient is required to lie completely still. Any body dynamics will result in blurred images. The doctor controls the CT scanner in the next room. The duration of the study is about 20 minutes.

MRI urography

It is also considered one of the subtypes of the excretory diagnostic procedure. Characterized by the use of magnetic tomography instead of x-rays. It is also a combined research technique. The main advantage is the high resolution, which ensures a high degree of information content of the procedure.

MR urography makes it possible to record the slightest deviations and sections in the structure of the urinary system. The excretory capacity of the paired organ is analyzed. The diagnostic procedure allows you to detect traces of traumatic lesions. There are a number of features. MRI urography is contraindicated in the following groups:

When the patient is using a pacemaker.
Presence of metal objects in the body.
Acute nature of kidney failure.
Epileptic seizures.
Pathological syndrome of claustrophobia.

If the above-described contraindications are present, another type of urography is used.

General preparation rules

Preparation for urography includes a number of rules; recommendations for undergoing a diagnostic procedure with and without the use of contrast do not differ.

It is necessary to make adjustments to the diet and give up foods that increase flatulence. The consumption of baked goods, milk, kefir, carbonated drinks, raw fruits and vegetables should be minimized.
If there is a tendency towards increased gas formation, it is recommended to take activated carbon once a day.
Before the study, a test is required to ensure that there is no allergic reaction to the contrast agent used. If there is a negative reaction of the immune system to drugs, you should notify your doctor in advance.
4-8 hours before the diagnostic procedure, you need to eat, but limit the amount of fluid consumed.
In the morning before urography, a light snack with unsweetened tea is recommended.
Before administering a contrast agent, you must remove all metal items from your body. At the request of a specialist, you should empty your bladder.

Special preparation of the patient allows you to obtain more accurate data about the condition of the body.

In case of nervous excitability and nervousness, the use of a sedative drug is allowed several hours before the test. Kidney urography in children is completely identical.

How is it carried out?

Initially, the patient is referred to a survey type of research technique; when pathological syndromes are detected, the excretory type is used.

The duration of the diagnostic procedure is determined by the severity of the pathological syndrome, the presence of stone deposits, their quantity and a number of other factors.

The survey type of research technique is performed with the patient in a standing position. An apron with lead plates is used to protect the chest area and pelvic organs. X-rays are directed to the area of the 3rd or 4th vertebrae.

To undergo a research technique with contrast, the patient lies on his back on the couch, after which an injection of a radiocontrast drug is performed. The beginning of the diagnostic procedure is characterized by some discomfort. As it spreads through the circulatory system, the drug penetrates the paired organ. When performing an excretory type of study, images are taken at intervals determined by the doctor; one image must be taken in a standing position.

If necessary, delayed images are prescribed; radiography is performed 2-4 days after the contrast injection. The average duration of the diagnostic procedure is 45 minutes.

After completion, all restrictions on diet and drinking regime are removed from the patient.

Regardless of the technique used, it is necessary to empty the esophagus before performing urography. Feces make it difficult to visualize the kidneys and urethra, which reduces the information content of the diagnostic procedure. If necessary, an enema or laxative drug is prescribed.

Possible side effects

There are no complications during the review diagnostic procedure. Uncomfortable sensations are possible during the examination using a contrast agent. In addition to a burning sensation and a metallic taste in the mouth, dizziness should also be noted.

If complications occur, the specialist performing urography should be notified. To remove the contrast agent from the body as quickly as possible, it is recommended to drink more dairy products, as well as green tea.

What does it show

After completing the urography, the doctor analyzes the images obtained and determines the following factors:

A description of the shape and dimensions of the paired organ is drawn up, and the features of their location are indicated.
The condition of the parenchyma structures is described.
The degree of efficiency of the cups and pelvis is determined.
The quality and speed of filling of the collecting system with urine is recorded.
The rate of urine outflow is determined.
When stone deposits are detected, their quantity, location, dimensions, and shape are indicated.
The consequences of injuries in the urinary tract are described.
The degree of progression of hydronephrosis is determined.

Urography is a modern diagnostic procedure that allows one to assess the condition of the genitourinary and renal systems and detect the development of the inflammatory process. Radiography is suitable for patients of all ages. Compliance with the rules of preparation for urography increases the degree of its information content.

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is excretory urography?

Excretory urography is a radiation diagnostic method based on the ability of the kidneys to secrete a contrast agent that was previously injected intravenously. Excretory urography is also called intravenous or contrast urography. Thus, the name reflects the essence of the method - a contrast agent is used, which is administered intravenously. The term “excretory” characterizes the main function of the kidneys, which is being studied. Urography is the gold standard and, in fact, the main method in the diagnosis of urological patients. The images obtained are called urograms.

Indirectly, according to excretory urography, one can judge the function of other organs of the genitourinary system.

Genitourinary system

The genitourinary system includes the kidneys, ureters, bladder and urethra. Urography is used for abnormalities of each of these organs.

The kidneys are a paired vital organ located in the lumbar region, on the sides of the spine. In the structure of the kidneys, parenchyma is distinguished ( the fabric itself) and the collecting apparatus, which performs the function of storing urine. At the exit, the renal pelvic system passes into the ureters. Each kidney has its own ureter. Through them, urine formed in the kidneys is collected in the bladder, since then the right and left ureters flow into it. The bladder stores urine until it is released through the urethra ( urethra) out. Thus, the course of urine in the body can be represented as follows - kidneys - ureters - bladder - urethra.

The main function of the kidneys is to excrete ( excretion) urine, which, in turn, is realized through filtration and secretion. It is these basic functions that are examined during urography. Normally, with good excretory capacity of the kidneys, the contrast introduced into the body is excreted by the kidneys in a 5% concentration. The contrast present in urine colors the contours of the urinary organs in which it is located. Therefore, the main criterion for urogram ( urography image) is a display of the outlines of the kidneys, ureters and bladder.

The method involves intravenous injection of a contrast agent into the blood, after which it spreads throughout the body. The substance is then transported to the kidneys and excreted through the urinary tract. X-ray images are taken 10 to 15 minutes after the substance is administered. They visualize excretion ( excretion) substances, and by how this happens, kidney function is judged. Thus, urography is nothing more than a radiography method using contrast.

As a rule, before performing excretory urography, a plain radiography is performed.

Intravenous contrast urography of the kidneys

Excretory urography of the kidneys is intravenous urography or urography using contrast. The purpose of this method is to assess the condition of the kidneys and urinary tract. The method consists of obtaining an image of the organs being examined on a monitor screen and on film. X-rays can be used to obtain images ( classical urography), computed tomography ( CT urography) or magnetic resonance imaging ( MRI urography).

Survey urography

Survey urography is an X-ray method for examining the genitourinary system, which is recommended to be done before intravenous urography. This is explained by the fact that often after a survey image there is no need for intravenous urography. Despite the seemingly low information content, this method is capable of detecting kidney stones, the presence of hematomas, and various anomalies in the development of organs of the urinary system.

Survey urography covers almost the entire urinary system - from the kidneys to the beginning of the urethra, including the spine. During survey urography, a so-called overview image is taken, from which any X-ray examination of a urological patient begins.

When interpreting a survey radiograph, the condition of the bone skeleton and soft tissues is taken into account ( if any are displayed), contours of the kidneys, shadow of the lumbar muscles.

The stages of description of survey urography include:

determining the position of the spine– significant curvature of the spine ( lumbarization, scoliosis) affect the functioning of the genitourinary system;
localization of the kidneys on both sides of the spine– normally the right kidney is located slightly lower than the left;
kidney outlines- normally homogeneous ( homogeneous);
shadow of the lumbar muscles– homogeneous, on the radiograph it takes the form of a truncated pyramid;
disappearance of the shadow of the lumbar muscles- indicates the presence of pathological changes - injuries, hemorrhages;
ureters– normally not visible on a survey image, the appearance of their contours indicates the presence of an inflammatory process;
bladder– is visualized only as a shadow, which has the shape of an ellipse.

CT urography

CT urography is an excretory urography, during which a computed tomograph is used instead of an X-ray. Thus, CT urography is a combined method of computed tomography and contrast of the kidneys.

Computed tomography is a modern diagnostic method for identifying various structural and functional anomalies, including the genitourinary system. The study is based on the same X-ray radiation. However, the advantage is that the method allows one to obtain layer-by-layer images of the organ. Thus, CT urography is more informative than simple urography.

Indications for CT urography are:

suspicion of stones in the kidneys, ureters, bladder;
chronic, periodically exacerbating urinary tract infections;
congenital anomalies of the kidneys, ureters, bladder;
suspected urinary tract blockage;
kidney and urinary tract injuries;
neoplasms ( tumors, kidney cysts) in the genitourinary system;
hematomas ( collections of blood) or abscesses ( accumulations of pus) in the kidneys.

During preparation for the study, the patient is recommended to have a hypoallergenic diet, as well as eliminating foods that cause bloating from the diet ( legumes, cabbage, sparkling water). A light lunch is recommended the day before, dinner is excluded and a cleansing enema is performed. An enema is also given on the day of the procedure. If the patient is characterized by excessive gas formation, then drugs that eliminate gas formation are recommended in parallel ( for example, espumizan).

The contrast agent is administered intravenously, most often using a catheter, less often using a dropper. The volume of the required substance is calculated using the formula - 0.5 milliliters per kilogram of body weight. Thus, the volume of contrast ranges from 30 to 50 milliliters. Regardless of the volume, the contrast is injected very slowly, at least over 2 to 3 minutes. At the same time, during the infusion of a contrast agent, the specialist conducting the procedure carefully monitors the patient’s condition. He monitors his blood pressure, pulse, skin. At the same time, the patient should be informed that during the procedure such sensations as a feeling of heat, dizziness, and mild nausea are possible.

After the contrast is administered, the patient is placed on a table that moves through the tomograph. During scanning, it must remain motionless, since the slightest movement leads to blurred images. The doctor is in a special room nearby and monitors the progress of the scan through the window and on the monitor. At the same time, he communicates with the patient, asks him about his health and gives recommendations. On average, a scan lasts from 15 to 25 minutes. Classically, three series of images are taken - at 5, 15 and 25 minutes.

MRI urography

MRI urography is an excretory intravenous urography, during which a magnetic tomograph is used instead of an X-ray. Thus, by analogy with CT urography, MRI urography is a combined method of magnetic resonance imaging and renal contrast. The advantage of the method is its high resolution, as a result of which the picture of the organ under study is as accurate as possible.

MRI urography allows you to see on the display screen, and then on film, the thinnest ( up to 0.1 millimeter) sections of the genitourinary system. The information makes it possible to differentiate the renal cortex and medulla and analyze their excretory function. Also, MRI urography can detect many forms of pathology, in particular volumetric processes ( benign and malignant tumors) in the genitourinary system, foci of inflammation and edema, hematomas, abscesses and even traumatic lesions.

Preparation and the first stage are similar to simple urography and CT urography. Bowel preparation and desensitization ( decreased sensitivity to the injected substance) organism.

The magnetic resonance imaging method is based on the principle of a magnetic field. So, the human body is placed in a chamber, which is nothing more than a magnet. Considering this fact, there are a number of, albeit narrow, contraindications to MRI urography.

Contraindications for MRI urography include:

the patient has a pacemaker ( pacemaker);
metal implants in the body - prostheses, electronic middle ear implants, hemostatic clips;
acute renal failure;
claustrophobia ( fear of closed spaces).

Retrograde urography

Retrograde urography is a variant of urography when a contrast agent is injected using a catheter through the urethra. Thus, with retrograde urography, the urinary tract is filled with contrast in an ascending manner - urethra - bladder - ureters - kidneys ( with excretory urography, the movement is reversed). The movement of contrast occurs in the opposite direction, hence the name of the study.

The injected contrast agent, as with conventional excretory urography, is impenetrable to X-rays and is clearly visible on photographs. It “outlines” the contours of the organs in which it is located, namely the bladder, ureters, and the collecting apparatus of the kidneys. The purpose of the method is to diagnose disorders of the patency, form and function of the urinary system. Indications for retrograde urography are not much different from those for conventional urography.

Indications for retrograde urography include:

pain in the lumbar region at rest and, most importantly, during movement;
blood in urine;
decreased daily urination ( diuresis);
suspicion of a cyst, hematoma and neoplasms in the kidneys;
injuries of the genitourinary system;
frequent recurrent ( escalating) kidney and bladder infections.

The advantage of retrograde urography is the minimal risk of allergic reactions. This is explained by the fact that during this procedure the contrast agent does not enter the blood, but only into the organs of the genitourinary system. Also, retrograde urography is the most informative in the diagnosis of certain diseases. For example, the maximum information content of the method is noted for vesicoureteral reflux ( PMR). VUR is a pathology in which there is reflux of urine from the bladder into the ureter. Thus, there is a movement of urine in the opposite direction. The consequence of this is an increase in pressure inside the ureter. This, in turn, can lead to urine reflux from the ureters into the kidneys. The end result of this phenomenon is frequent infections, the development of hydronephrosis and atrophy of the renal tissue.

To diagnose reflux, a variant of retrograde urography is used, which is called voiding cystourethrography. It consists in filling only the bladder with a contrast agent. This is done using a special catheter. After filling, the patient empties the bladder, that is, urinates. Next, photographs are taken. With vesicoureteral reflux, contrast is thrown into the ureters, which should not normally occur.

How is intravenous excretory urography done?

So, the method takes place in two stages - intravenous injection of a contrast agent into the blood and taking pictures directly. To carry out the first stage of the study, iodine-containing substances are used, which subsequently filter from the blood into the urine and color the latter. Urine stained with a contrast agent subsequently “reveals” the organs in which it is located. For contrast, substances such as urografin and urotrast are used.

As a rule, the following contrast agents are used when performing urography:

urografin;

iodamide;
isopak;
ultravist;
hexabrix;
omnipack.

The second stage is to take images that directly visualize the distribution of the substance. This stage can be carried out in several ways. The classic option is the use of x-rays. However, it is also possible to use computed tomography ( CT urography) or magnetic resonance imaging ( MRI urography). One way or another, the essence of the second stage is to visualize the process of secretion of the substance by the kidneys. How quickly the substance is distributed and where it gets stuck tells the specialist about kidney function.

Indications and contraindications for intravenous urography

Despite the simplicity of the method, urography should be performed strictly for medical reasons. It is resorted to only if the method cannot be replaced by other, less invasive studies. The main condition is that the expected benefit of the study must exceed the possible risk. The greatest risk group in this case are women during pregnancy. Research in this category of patients is carried out only for exceptional indications.

Indications for excretory urography are:

blood in urine ( hematuria);
frequent urinary tract infections;
suspicion of a tumor process in the kidneys;
obstruction ( blockage) urinary tract;
lower back pain.

At the same time, there are contraindications for intravenous urography. These are mainly decompensated conditions - renal failure, severe defects of the cardiovascular system. An absolute contraindication to the study is an allergy to iodine. A relative contraindication is, in principle, a history of allergies.

Contraindications for excretory urography include:

pathologies of the cardiovascular system in the stage of decompensation;
renal failure;
severe thyrotoxicosis;
allergy to iodine-containing substances.

Algorithm for urography

The algorithm for performing excretory urography is standard. However, based on the individual characteristics of each patient, the doctor determines the order of the study. In this case, the medical history, clinical picture of the disease at the time of the study, as well as data from laboratory and instrumental studies must be taken into account. The patient’s allergy history is very important, that is, clarification of previous allergic reactions, the presence of allergies among close relatives.

So, the first stage consists of intravenous administration of a contrast agent. It is injected into one of the peripheral veins, usually into the vein of the elbow. With retrograde urography, the substance is injected using a catheter directly into the urethra. The volume of the administered substance is calculated based on 0.5 milliliters per kilogram of body weight. On average, no more than 50 milliliters of the substance is administered. The injection rate is 0.2 milliliters per second. Thus, the drug administration time should be at least 3 to 5 minutes. During this time, the doctor monitors the patient and his vital signs.

The parameters that the doctor monitors during urography include:

blood pressure– it is not allowed for the patient’s blood pressure to drop by more than 10 - 15 millimeters of mercury from the original figures;
heart rate, that is, pulse– should not be less than 60 and no more than 90 beats per minute;
respiration rate– should not exceed 20 respiratory movements per minute;
skin condition– color and humidity, because sharp pallor of the skin indicates a sharp drop in blood pressure.

The second stage begins with taking x-rays. If we are talking about CT urography or MRI urography, then images corresponding to these studies are taken. As a rule, three pictures are taken at intervals of 5 to 10 minutes. However, depending on the individual characteristics of each patient ( his age, medical history), the doctor can take as many pictures as he deems necessary.

Mandatory photographs during urography include:

first photo– done 5 minutes after contrast administration;
second photo– performed between 12 and 15 minutes of the study;
third photo– carried out at 25 minutes of the study.

Additionally, most often, the radiologist resorts to so-called delayed images, which are taken half an hour after the administration of contrast. The patient is in a prone position or in an upright position. Next, the doctor directly begins to evaluate the images.

Allergic reactions during urography

Allergic reactions to contrast media can be classified as mild, moderate, or severe. One of the most dangerous unpredictable reactions to a contrast agent is anaphylactic shock. Anaphylactic shock is characterized by a lightning-fast reaction with a drop in blood pressure, obstruction ( obstruction) respiratory tract and a high percentage of mortality ( mortality).

Allergic reactions to contrast media

These side effects, by contrast, refer to general allergic reactions affecting the entire body. However, side effects can also be local or directly toxic. The first include those reactions that develop at the site of administration of the substance, namely phlebitis or necrosis of soft tissues. Phlebitis refers to inflammation of the wall of the vein into which a contrast agent was injected. Soft tissue necrosis is the death of the skin and underlying tissue in the area of the injection.

Direct toxic side effects include nephrotoxicity, cardiotoxicity and neurotoxicity. This means that some contrast agents can selectively affect certain organs, affecting them. For example, cardiotoxicity is a selective damage to heart cells, and nephrotoxicity refers to damage to kidney tissue. However, it is worth noting that modern contrast agents used in excretory urography extremely rarely have such side effects.

First aid measures for an allergic reaction include:

injection of 10 milliliters of sodium thiosulfate;
subcutaneous injection of 1 milliliter of adrenaline;
antihistamines, like diphenhydramine, are also administered intramuscularly ( diphenhydramine) or chloropyramine.

Next comes the preparation of the patient for the study. It includes restricting food and fluid intake for at least 18 hours before the test. The main goal of preparation is maximum emptying of not only the bladder, but also the intestines. This is done in order to avoid gas contamination of the intestines, which significantly complicates the visualization of the genitourinary system. If the patient does not follow a diet that prevents the formation of gases in the intestines, then on the eve of the study the intestines will be swollen, and this will create “interference” with a clear picture.

Preparation for urography

The main principle of preparation is diet and bowel cleansing on the eve of the study. On the day of the procedure, the patient’s fluid intake is increased so that the contrast is eliminated from the body faster. The patient must be informed about the upcoming procedure, namely the nature of the study and possible side effects. The patient should also be explained that during the procedure itself he will also experience various sensations - fever, slight dizziness. This is especially important for patients with labile ( unstable) nervous system. If a person simultaneously suffers from panic attacks or anxiety disorder, then it is first recommended to administer an anxiolytic ( more often - diazepam).

The stages of preparation for urography include:

taking a biochemical blood test - carried out a few days before the test in order to assess kidney function;
testing for intolerance to iodine-containing drugs is also carried out in advance;
a hypoallergenic diet excluding citrus fruits, chocolate, seafood is recommended for everyone ( both patients with risk factors and patients without them) – carried out over 5 days;
a diet that reduces gas formation and excludes fresh fruits and vegetables, legumes, sweet foods and brown bread from consumption - carried out 2 days before the procedure;
the day before the study it is recommended to exclude dinner;
cleansing enema on the eve of the study;
On the day of the study, repeat the enema and exclude breakfast.

The greatest difficulty in preparing for intravenous excretory urography is presented by young patients, namely children under four months of age. This is explained by the fact that, due to the anatomical features, their intestines are very swollen and gassy. Therefore, even with the use of carminatives ( espumisan), it is not always possible to achieve good bowel preparation. This, in turn, significantly limits the possibilities of urography.

An integral part of preparation for urography is the prevention of possible complications and, first of all, the prevention of allergic reactions. It is based on careful collection of anamnestic data in order to identify risk factors. If at least one of the risk factors is identified, the doctor must weigh the balance of possible benefits and dangers of the planned study.

Risk factors for complications during urography include:

history of allergies to iodine-containing substances;
previous allergic reactions to any medications;
chronic renal failure;
patient age over 65 years;
dehydration of the body;
chronic diseases in the acute stage.

One way or another, the X-ray room must be equipped with the necessary set of medications, among which, first of all, sodium thiosulfate and prednisolone. It is worth noting that some clinics use the tactic of premedicating patients with prednisone. This means that patients at risk are given 50 milligrams of prednisolone before the study. This is done twice - 10 and 5 hours before the diagnostic procedure.

Cardiovascular drugs are used to provide emergency care for anaphylactic reactions ( dopamine), means that stimulate respiration, oxygen.

Urography pictures

During urography, images are taken ( urograms or nephrograms), by which kidney function is assessed. The main criterion for kidney functionality is contrast time ( staining) pyelocaliceal apparatus and also the intensity of this contrast. Slow and low-intensity staining indicates reduced excretory function of the kidneys. In addition, urograms also describe other organs of the urinary system - ureters, bladder. In dark photographs, due to the accumulation of the drug in them, they appear as light structures.

Provisions in the description ( assessment) urography is as follows:

description of the cups and pelvis - their shape, structure, accumulation of contrast in them;
description of the ureters ( in this case the left and right ureter are compared) – their diameter, position, the presence of twisting or ornateness, the structure of the walls, the movement of contrast along them;
characteristics of the bladder - size, shape, position, contours of the walls.

Description of urography images is normal

Organ	Description OK
*Ureters*	They look light ( shadow) stripes with a width of 2 to 5 millimeters, which are displayed in fragments. The ureter itself, due to its structural features and the presence of certain structures ( cystoids) along its entire length is represented by areas of expansion and contraction. The widened areas are filled with contrast and therefore appear light in the image, while the narrow areas are represented by darkening.
*Bladder*	It plays the role of a reservoir, and therefore a large amount of contrast accumulates in it in delayed images. Within normal limits, the shape of the bladder can vary from round to pear-shaped and even pyramidal. The upper border of the organ is located at the level of the 3rd and 4th sacral vertebrae, while the lower border reaches the pubic joint. The contours are normally clear, even and slightly convex.
*Pyelocalyceal system*	Each healthy kidney has 4 calyces that open into the pelvis. The pelvis is a funnel-shaped cavity in which urine accumulates, and then passes into the ureter. Small cups ( normally from 6 to 12), from which larger ones subsequently form, are not always visible in the image. This kidney structure is the first to be filled with contrast material in the images. Also in delayed shots ( at 30 minutes) Normally, tight filling of the pelvis system is recorded.

Each pathology has its own types of urograms. For example, with tubular necrosis, a so-called dense nephrogram is observed. It is characterized by the fact that maximum staining is observed at the end of contrast administration. However, unlike the norm, this picture persists for many hours. When taking delayed images, the doctor also records the maximum dense staining of the kidneys. In acute pyelonephritis ( inflammation of the collecting apparatus) a dense nephrogram is also noted, but the pelvis and calyces are practically not stained on it. When the urinary tract is blocked, the site of occlusion ( blockages) corresponds to the place where staining stops. So, the kidney secretes colored urine, as can be seen in the picture, to the point of blockage. This can be seen in the image by the fact that the colored stripe of the ureters stops, and after it the contours of the organ are not visualized. A variant of the pathological urogram includes a silent kidney. This term is used to describe the phenomenon when there is no shadow of the contrast agent in the image.

Excretory urography of the kidneys in children

Excretory urography is the most commonly used diagnostic method in pediatric nephrology practice. As in adults, several of its variants are used - retrograde urography and voiding cystography.

Indications for excretory urography ( and its types) in children are:

kidney and urinary tract injuries ( bladder and urethra);
tumors in the pelvis;
inguinal hernias accompanied by urination disorders;
control after surgery on the urinary system and rectum;
chronic urinary tract infection;
suspicion of vesicoureteral reflux;
congenital nephropathies;
microhematuria ( the presence of blood in the urine, which is not detectable with the naked eye);
difficult and rare urination.

Contraindications include acute infections ( acute pyelonephritis and urethritis) and the serious general condition of the child. A relative contraindication to urography is macrohematuria - the presence of blood in the urine, which is accompanied by noticeable redness.

Contraindications for excretory urography in children include:

acute and chronic renal failure;
allergy to iodine and non-iodine contrast agents;
tuberculosis in the active phase;
liver failure;
thyrotoxicosis.

The main difficulty in conducting excretory urography in children is preparation for this study. Thus, the quality of the radiograph is influenced by the preparation of the child’s gastrointestinal tract, namely its cleansing of feces and gas. Considering the characteristics of the digestive tract in children, preparation for the study is somewhat different from adults.

Features of preparation for urography in children are as follows:

On the day of the study, the child is allowed breakfast. So, an hour before the test, children are given porridge or a small bun with tea. This is done in order to avoid the formation of “hungry” gases.
Newborn children ( up to a year) It is recommended to skip breakfast on the day of the study. However, once the examination begins, they begin to feed him using a pacifier.
2-3 days before the test, foods rich in carbohydrates are excluded from the diet. The list of products includes raw vegetables, cow's milk, and black bread. This is done to prevent the accumulation of gases in the colon ( aerocolia).
Sorbents are prescribed ( activated carbon), carminatives ( espumisan), chamomile infusion. For easily excitable children, a decoction based on valerian root is recommended.
The day before, two cleansing enemas are done using Vaseline oil. So, oil in a volume of 30 milliliters is given to the child orally, and two hours later two enemas are given. The procedure with oil is repeated on the day of the study.
For older children, instead of an enema, ordinary laxatives are recommended - Duphalac, Microlax.

Intravenous urography in children also takes place in two stages. The first is the introduction of a contrast agent. The second is taking pictures. The volume of substance required is calculated based on age, body weight or surface area ( in square meters) child's body. The average amount of the drug for a child under 5 years old is 15 milliliters, for a child 10 years old – 20 milliliters. The method of administering contrast is slightly different. So, it is recommended to initially introduce one milliliter of solution, then take a three-minute pause. During this pause, the doctor monitors the child’s condition – his blood pressure, skin, breathing. If there are signs of an allergic reaction ( redness, rapid heartbeat) no, then the administration of the substance continues. If blood pressure begins to fall and the pulse becomes faster, the procedure is suspended. The rate of contrast administration depends on the type of urography. So, with infusion urography, the speed is 150 drops per minute.

The second stage consists of taking pictures, which are taken at 5, 10, 20 and even 40 minutes after the administration of contrast. After the procedure is completed, the child should be monitored for several more hours. This is explained by the fact that most side effects develop in the first hours after the study.

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Excretory urography is a common method for diagnosing diseases of the genitourinary system, which is based on the ability of the kidneys to remove contrast agents from the blood. After intravenous administration of the same contrast agent, an x-ray examination of the kidneys and urinary tract is performed, thanks to which you can see their anatomical picture and determine the pathology.

Indications for performing excretory urography

Until the invention of the ultrasound apparatus, excretory urography was considered the real “gold standard” in urological practice. It was performed in all cases of patient admission to the urological hospital, regardless of the patient’s disease. After the invention of ultrasound, the range of indications narrowed somewhat, but it still remains wide enough to consider excretory urography one of the most common diagnostic methods in urology.

One of the most common indications for excretory urography is blood in the urine. There can be many reasons for this clinical condition, and in order to determine at least an approximate cause of the disease, it is necessary to immediately perform excretory urography.

Pain syndrome associated with pathology of the kidneys and urinary tract is also an absolute indication for excretory urography.

In addition, any traumatic injury to the lumbar region or any infectious pathology of the urinary tract also requires mandatory excretory urography.

Also, despite the invention of ultrasound, there are still pathologies for which excretory urography remains the most reliable diagnostic method. This may be a suspicion of ureteral obstruction or urolithiasis. The fact is that ultrasound does not make it possible to visualize abdominal organs, such as the ureter and bladder, but with excretory urography one can clearly see their anatomical picture and the presence of pathology.

In addition to all of the above, excretory urography is used to diagnose congenital anomalies or complications after surgical interventions.

Contraindications for performing excretory urography

In part, one of the reasons for the more frequent use of ultrasound instead of excretory urography can be considered a large number of contraindications to this diagnostic method. Naturally, the procedure is strictly prohibited in case of increased sensitivity to iodinated contrast agents. At the same time, the method is abandoned altogether or it is recommended to use other contrast agents that do not contain iodine.

Previously it was said that any infectious diseases of the genitourinary system are indications for excretory urography. At the same time, it must be remembered that autoimmune inflammation, on the contrary, is considered a contraindication for performing this diagnostic method. Therefore, before performing excretory urography for inflammatory pathology, the patient should undergo a list of laboratory tests to clarify the cause of the pathology.

For the same reasons, the procedure cannot be performed in case of renal failure, regardless of whether it is acute or chronic. A contrast agent can become an additional burden for a diseased kidney, so for this pathology it is better to limit yourself to ultrasound only.

In diseases such as pheochromocytoma and thyrotoxicosis, the administration of iodine-containing contrast can cause a sharp increase in blood pressure, therefore excretory urography is strictly contraindicated in such patients.

Preparation for the procedure

In principle, there is no preliminary preparation for excretory urography. The entire procedure, from start to finish, is performed directly in the medical facility. The only preparation for excretory urography may be a psychological attitude for those who are afraid of intravenous drips and injections.

In addition, domestic healthcare institutions very rarely provide consumables for the procedure. Therefore, if you have been prescribed excretory urography, then be prepared for the fact that you will have to buy a syringe and iodine-containing contrast at the pharmacy. In order not to return to the same place twice, it is better to go to the pharmacy before going to the clinic.

Excretory urography through the eyes of the patient

For the patient, the procedure begins with an intravenous injection, when he is injected with a contrast agent. The amount of contrast does not depend on the patient’s age or disease, but on body weight. After the contrast agent is injected, the patient waits about five minutes before being taken to the X-ray room, where a series of images are taken. The first image is taken at 5-7 minutes, when the contrast agent is in the cavity of the renal collecting system. The second radiograph is taken at 10-15 minutes. It is responsible for filling the ureters with contrast. And the last third image must be taken at 20-25 minutes, when the contrast enters the bladder cavity.

In some cases, for example, with ureteral obstruction, when there is a delay in the removal of the contrast agent, the patient needs to “film” himself two more times - at 45 and 60 minutes. In principle, this is where all actions on the part of the patient end. Patients need to remember that after intravenous administration of contrast, urine may change its normal color to a darker one, which should not be feared.

Doctor’s tasks during excretory urography

The urologist himself is not directly involved in excretory urography. This is done by a nurse who administers the contrast agent and an x-ray technician who takes the images. The doctor is faced with a completely different task - he needs to correctly interpret x-ray images and make a medical conclusion based on them.

When describing the images, a urologist evaluates the shape, position, size and contours of the kidneys, on the basis of which a conclusion is made about the functional state of the organ. In addition, the contours and shape of the ureters and bladder are assessed. A positive quality of excretory urography is that the images can assess not only the condition of the urinary tract, but also the pelvic organs. This is how accidental medical findings, such as cancer of internal organs, are often identified.

Normal excretory urogram

Duration of the procedure and length of hospital stay

As a rule, no more than half an hour passes from the moment of administration of the contrast agent to the moment of the last x-ray image. In rare cases, due to the reasons mentioned above, this procedure can last 45 or 60 minutes. At the same time, a hospital stay is not at all necessary for this procedure. On the contrary, more often it is performed on an outpatient basis.

The literature also describes cases where the procedure itself became the reason for the patient’s hospitalization. These are serious allergic reactions to the injection of a contrast agent. As practice shows, the duration of hospital stay in such situations does not exceed two weeks, during which patients undergo a thorough allergy examination and are given further recommendations regarding the treatment and prevention of the disease. Also, to prevent such situations, the room for excretory urography should have everything necessary to provide first aid.

Possible complications during excretory urography

The most common complication during excretory urography is allergic reactions to the administration of iodine-containing contrast. They manifest themselves in the form of a runny nose, sneezing, shortness of breath, redness and swelling on the skin of the face. First medical aid in this case consists of administering hormonal drugs, such as prednisolone or hydrocortisone. To prevent such situations, it is necessary to carefully collect an allergy history. The risk group is patients with allergic reactions to the administration of contrasts, with other severe allergies, as well as patients with bronchial asthma.

In addition, there are frequent cases of local complications when performing intravenous injection. The most common complication is post-injection hematoma, which occurs due to poor pressing of the cotton wool to the punctured vein at the injection site. As a result, large quantities of blood enter the subcutaneous fatty tissue, where a hematoma is formed. In principle, it tends to self-resolve even without the use of any specific treatment.

But sometimes suppuration of the hematoma can occur. Then patients experience redness and swelling of the skin around the injection site. As for general symptoms, patients may complain of increased body temperature, weakness, malaise and loss of appetite. In such cases, immediate surgical intervention is necessary, which consists of opening and draining the hematoma cavity.

In addition, quite often a local complication such as thrombophlebitis can occur. It is an inflammation of the inner wall of the vein at the site of its puncture. At the same time, redness is also noted in the injection area, only it has the appearance of an oblong cord, which coincides with the subcutaneous direction of the vein. Unlike hematoma, thrombophlebitis does not require surgical treatment, but conservative treatment with anti-inflammatory and antibacterial agents.

Most often, complications are observed when performing this procedure in patients who have contraindications to excretory urography. For example, when a contrast agent is administered to patients with glomerulonephritis or renal failure, the function of this organ may be impaired. Patients then complain of pain in the lumbar region and deterioration of their general condition. In laboratory indicators, their levels of urea and creatinine sharply increase, and the amount of total protein decreases. This has a very poor prognosis and may result in uremic coma. Therefore, all patients must be examined very carefully before excretory urography.

Ed. urologist, sexologist-andrologist A.N. Plotnikov