This summary was prepared by Dr Felicity Goodyear-Smith, Goodfellow Unit, Department
of General Practice & Primary Health Care, The University of Auckland and Dr
Stephen Wood, Radiology Registrar, Auckland.
Intravenous Urography
About IVU
Indications for IVU:
These will vary in different locations depending on the preference of different
practitioners and on the availability of other modalities for investigation.
- Renal colic (although CT and US are often used):
- visualise stones on plain radiograph
- delayed excretion of contrast media
- site and degree of obstruction
- Haematuria (in conjunction with other tests ie US and cystoscopy):
- assess renal outline, pyelocalyceal system, ureters, bladder, urothelium.
- Recurrent UTI (US usually first line but can use IVU to assess the following):
- congenital urinary tract abnormality
- strictures
- urothelial lesion
- Renal tract masses or suspicion of neoplasm (usually require investigation with
US and/or CT)
- Urinary tract obstruction-(eg from a pelvic mass)
-
Other indications:
- prostatism
- trauma
- neurogenic bladder
Not usually indicated for:
This will depend on local practice guidelines but IVU is not usually indicated in
the following situations:
- acute pyelonephritis
- renal failure
- renal parenchymal
- disease hypertension
Description of procedure
Following a preliminary plain radiograph, a contrast media is injected intravenously
which is excreted by the kidney. This allows visualisation of the renal outline
and then as the contrast passed into the collecting system the renal pelvices, ureters
and bladder can be assessed.
Advantages of IVU:
- Widely available
- Excellent definition to assess the urinary tract epithelium
- Can visualise the ureters throughout their length
- Can quantify the degree of obstruction of the urinary tract
Disadvantages of IVU:
- Requires some patient preparation.
- Use of ionising radiation. This is mainly a concern in repeated use and investigation
during pregnancy.
- Contrast media-potential problems:
- Previous allergic reaction
- Renal failure
- Diabetics on metformin with impaired renal function
- May get sub-optimal results due to:
- Patient movement
- Overlying bowel gas
- Body habitus
- Poor concentration of contrast media in a poorly functioning kidney
- Obesity (applies to
all imaging)
- The test may need to be delayed if the patient has:
- Failed to fast
- Had recent barium studies
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Images from Intravenous Urography
Click on these images for an enlarged view - opens in a separate window which you
will need to close.
Three Bladder Calculi |
Transitional Cell Carcinoma |
Crossed Renal Ectopia on the Left Kidney and Absent Right Kidney |
Right Kidney has Duplex Collecting System |
Extravasation of Contrast from Left Kidney Secondary to High Grade Obstruction |
Horseshoe Kidney - Tissue Bridge Across Midline Causes Abnormal Orientation of Renal
Axis |
Ureteric Calculus Over line of Left Renal Tract - No Contrast Medium Given as 1st
in Series |
Dilation of Left Renal Pelvis and Calyces Above the Obstructing Calculus - Following
Administration of Contrast 2nd in Series |
Normal IVU - Contrast Outlines Renal Collecting Systems: Ureter and Bladder |
Filing Defect secondary to Calculus Causing Obstruction in Left Ureter |
Pyelo-ureteric Junction Obstruction Shows as Dilation of Right Renal Pelvis and
Calyces |
Staghorn Kidney - Film Also Shows TL Clips |
Staghorn Kidney - Left |
|
|
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Patient Information
This patient information is available
as a PDF file from which you may print copies - you will need an acrobat reader.
Information for the patient on IVU:
- Intravenous urography (IVU) is also known as excretory urography or intravenous
pyelography. This examination provides images of your kidneys, ureters and bladder.
It can be used to:
- Investigate causes for blood in the urine;
- In particular to look for tumours of the kidneys, ureters or bladder (this would
usually also involve other types of test);
- Investigate possible kidney stones (renal colic); and
- Investigate causes for repeated urinary tract infections (if thought necessary by
your doctor).
How it works
After an initial plain X-ray, a dose of contrast media or dye is injected intravenously.
This is excreted by the kidneys and allows visualisation of the renal system on
subsequent X-ray films (structures that are not normally seen on regular X-rays).
Preparation:
- The procedure is usually done on an outpatient basis.
- Depending on local practice you may be asked to follow a procedure to prepare you
for the test - this may include oral laxatives or fasting.
- You should inform your own doctor or radiology staff if you think you may be pregnant.
The procedure:
- The procedure usually takes about 1 hour. Test time may vary due to specific doctor
requests.
-
On arrival you will generally need to be dressed in a hospital gown and have an
initial X-ray.
- A small intravenous line is placed in the arm and the contrast media is injected.
This may be accompanied by a warm feeling and an odd taste in the mouth. You should
inform staff if you have experienced problems with contrast media previously.
- Following the injection a series of X-ray films will be taken as the contrast is
excreted allowing the different parts of the renal tract to be visualised.
Discomfort:
- Possible minor discomfort of injection;
- Flushing or light-headedness during dye injection.
- Positioning and coolness of room and equipment may cause some minor discomfort.
Risks and Contra-indications:
- Possible allergic reaction to the contrast dye.
- Radiation exposure particularly if the procedure is repeated several times.
- People with diabetes and renal system impairment are
at risk of acute renal failure.
After-care:
- There are no specific aftercare procedures.
- Your attending doctor will discuss the results of your IVU with you.
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