Intravenous pyelogram

Answer 1

Definition

An intravenous pyelogram (IVP) is a special x-ray examination of the kidneys, bladder, and ureters (the tubes that carry urine from the kidneys to the bladder).

Alternative Names

Excretory urography; IVP

How the test is performed

An IVP is done in a hospital radiology department or a health care provider's office by an x-ray technician.

You will need to empty your bladder immediately before the procedure starts.

The health care provider will inject an iodine-based contrast (dye) into a vein in your arm. A series of x-ray images are taken at different times to see how the kidneys remove the dye and how it collects in your urine.

A compression device (a wide belt containing two balloons that can be inflated) may be used to keep the contrast material in the kidneys.

You will need to remain still during the procedure, which may take up to an hour.

Before the final image is taken, you will be asked to urinate again, to see how well the bladder has emptied.

You can resume your normal diet and medications after the procedure. You should drink plenty of fluids to help remove all the contrast dye from your body.

How to prepare for the test

As with all x-ray procedures, tell your health care provider if you:

• Are allergic to contrast material
• Are pregnant
• Have any drug Allergies

Your health care provider will tell you whether you can eat or drink before this test. You may be given a laxative to take the afternoon before the procedure to clear the intestines so your kidneys can be clearly seen.

You must sign a consent form. You will be asked to wear a hospital gown and to remove all jewelry.

How the test will feel

You may feel a burning or flushing sensation in the arm and body as the contrast dye is injected. You may also have a metallic taste in the mouth. This is normal and will quickly disappear.

Some people develop a headache, nausea, or vomiting after the dye is injected.

The belt across the kidneys may feel tight over your belly area.

Why the test is performed

An IVP can be used to evaluate:

• Bladder and kidney infections
• Blood in the urine
• Flank pain(possibly due to kidney stones)
• Tumors
• The urinary tract for damage after an abdominal injury

What abnormal results mean

The test may reveal kidney diseases, birth abnormalities, tumors, kidney stones, and inflammation caused by infections.

Additional conditions under which the test may be performed:

• Acute arterial occlusion of the kidney
• Acute bilateral obstructive uropathy
• Acute kidney infection
• Acute unilateral obstructive uropathy
• Analgesic nephropathy
• Atheroembolic renal disease
• Benign prostatic hyperplasia
• Bilateral hydronephrosis
• Carcinoma of the renal pelvis or ureter
• Chronic bilateral obstructive uropathy
• Chronic glomerulonephritis
• Chronic unilateral obstructive uropathy
• Complicated UTI (pyelonephritis)
• Cystinuria
• Injury of the kidney and ureter
• Medullary cystic disease
• Polycystic kidney disease
• Prostate cancer
• Reflux nephropathy
• Renal cell carcinoma
• Renal papillary necrosis
• Renovascular hypertension
• Retroperitoneal fibrosis
• Unilateral hydronephrosis
• Ureterocele
• Wilms tumor

What the risks are

There is a chance of an allergic reaction to the dye, even if you have received contrast dye in the past without any problem. If you have a known allergy to iodine-based contrast, an alternate test should be performed. Alternatives include retrograde pyelography, MRI, or ultrasound.

There is low radiation exposure. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the risk is low compared with the benefits.

Pregnant women and children are more sensitive to the risks of radiation.

Special considerations

Computed tomography (CT) scans has replaced IVP as the main tool for checking the urinary system. CT takes less time to perform and provides additional views of the abdomen, which can help rule out other possible reasons for the patient's symptoms. Magnetic resonance imaging (MRI) is also used to look at the kidneys, ureters, and bladder.

References

Norrby SR. Approach to the patient with urinary tract infection. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 306.

Answer 2

Definition

An intravenous pyelogram (IVP) is a special x-ray examination of the kidneys, bladder, and ureters (the tubes that carry urine from the kidneys to the bladder).

Alternative Names

Excretory urography; IVP

How the test is performed

An IVP is done in a hospital radiology department or a health care provider's office by an x-ray technician.

You will need to empty your bladder immediately before the procedure starts.

The health care provider will inject an iodine-based contrast (dye) into a vein in your arm. A series of x-ray images are taken at different times to see how the kidneys remove the dye and how it collects in your urine.

A compression device (a wide belt containing two balloons that can be inflated) may be used to keep the contrast material in the kidneys.

You will need to remain still during the procedure, which may take up to an hour.

Before the final image is taken, you will be asked to urinate again, to see how well the bladder has emptied.

You can resume your normal diet and medications after the procedure. You should drink plenty of fluids to help remove all the contrast dye from your body.

How to prepare for the test

As with all x-ray procedures, tell your health care provider if you:

• Are allergic to contrast material
• Are pregnant
• Have any drug allergies

Your health care provider will tell you whether you can eat or drink before this test. You may be given a laxative to take the afternoon before the procedure to clear the intestines so your kidneys can be clearly seen.

You must sign a consent form. You will be asked to wear a hospital gown and to remove all jewelry.

How the test will feel

You may feel a burning or flushing sensation in your arm and body as the contrast dye is injected. You may also have a metallic taste in your mouth. This is normal and will quickly disappear.

Some people develop a headache, nausea, or vomiting after the dye is injected.

The belt across the kidneys may feel tight over your belly area.

Why the test is performed

An IVP can be used to evaluate:

• An abdominal injury
• Bladder and kidney infections
• Blood in the urine
• Flank pain(possibly due to kidney stones)
• Tumors

What abnormal results mean

The test may reveal kidney diseases, birth defects of the urinary system, tumors, kidney stones, or damage to the urinary system.

Additional conditions under which the test may be performed:

• Acute arterial occlusion of the kidney
• Acute bilateral obstructive uropathy
• Acute kidney infection
• Acute unilateral obstructive uropathy
• Bilateral hydronephrosis
• Carcinoma of the renal pelvis or ureter
• Chronic bilateral obstructive uropathy
• Chronic unilateral obstructive uropathy
• Hydronephrosis (swelling of one kidney due to a backup of urine)
• Injury of the kidney and ureter
• Medullary cystic disease
• Polycystic kidney disease
• Reflux nephropathy
• Renal cell carcinoma
• Renal papillary necrosis
• Renovascular hypertension
• Retroperitoneal fibrosis
• Ureterocele
• Wilms tumor

What the risks are

There is a chance of an allergic reaction to the dye, even if you have received contrast dye in the past without any problem. If you have a known allergy to iodine-based contrast, an alternate test should be performed. Alternatives include retrograde pyelography, MRI, or ultrasound.

There is low radiation exposure. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the risk is low compared with the benefits.

Pregnant women and children are more sensitive to the risks of radiation.

Special considerations

Computed tomography (CT) scans have replaced IVP as the main tool for checking the urinary system. CT takes less time to perform and provides additional views of the abdomen, which can help rule out other possible reasons for the patient's symptoms. Magnetic resonance imaging (MRI) is also used to look at the kidneys, ureters, and bladder.

References

Bhayani SB, Siegel CL. Urinary tract imaging: Basic principles. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 4.

Reviewed By

Review Date: 10/11/2010

Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.