Urography (Pyelography)

Urography (Pyelography)

What is urography?

Urography is an X-ray procedure employed to examine the kidneys and their draining tubes, known as ureters.

A specialized dye is administered to highlight any disparities or abnormalities in the kidneys, and to assess the size and shape of the bladder. This procedure is often referred to as an intravenous urogram (IVU).

When is an IVU utilized?

IVU is the predominant X-ray method for evaluating various kidney-related issues, such as:

- Kidney pain
- Suspected kidney stones
- Hematuria (blood in the urine)
- Suspected obstruction
- Suspected congenital abnormalities

How is an IVU conducted?

Before the test, the patient may be instructed to take a mild laxative to clear the bowel, as a full bowel could obscure X-ray images.

During the procedure, the patient lies on an X-ray table. After an initial X-ray of the kidney and bladder region, a dye is injected into a vein in the hand or arm.

The dye travels through the bloodstream to the kidneys, fills their collecting system, and then proceeds through the ureter to the bladder.

Sequential X-ray images are captured to monitor the dye's movement, typically at intervals of five minutes, 20 minutes, and after bladder emptying. Additional X-rays may be taken to pinpoint any obstruction sites.

A compression device across the lower abdomen may be used to enhance image quality, which is not painful.

Retrograde urography, another X-ray examination of the urinary system, is usually performed alongside cystoscopy under general anesthesia.

A catheter is inserted into the ureter, and dye is injected directly to outline the kidney and ureter channels.

Is an IVU risky?

There's a slight risk of iodine allergy with the dye used in IVU, particularly for individuals with allergies, hay fever, or asthma. In such cases, alternative investigations may be considered, or corticosteroids may be administered to suppress allergic reactions.

Diabetic patients taking metformin should discontinue its use 48 hours before an IVU. Pregnant women are generally advised against IVU unless the potential benefits outweigh the risks to the fetus.

Patients with severe liver, heart, or kidney conditions may require specific instructions from a specialist before undergoing IVU.

Although there's a minimal risk of X-ray side effects, modern X-ray technology is designed to produce high-quality images using minimal radiation doses. IVU is less common nowadays due to the increasing use of alternative imaging techniques such as MRI, CT, and ultrasound for kidney assessments.