Intravenous Pyelogram (IVP)

• Intravenous pyelography (IVP) is a special x-ray examination of the kidneys, bladder, and ureters.
• IVP is also called Intravenous Urogram.
• An IVP can show the size, shape, and position of the urinary tract.
• An IVP can evaluate the collecting system inside the kidneys.
• An IVP can be done as an emergency procedure without any preparation.

Indications for IVP

• Abdominal injury
• Ureteric fistulas and strictures
• Bladder and kidney infections
• Blood in the urine
• Flank pain (possibly due to kidney stones)
• Tumors

Advantages of IVP

• Detailed anatomy of the collecting systems
• Demonstration of major calcification
• Sensitive for acute obstruction
• Low cost

Limitations of IVP

• Depends on kidney function
• Does not differentiate solid or cystic lesions
• Requires contrast medium and radiation
• May miss small stones
• Study quality may be limited by inadequate bowel preparation, bowel ileus, swallowed air and technician variability.
• Inconvenience of a long filming sequence.

How is it Performed?

• During IVP, a dye called contrast material is injected into a vein in the patient's arm.
• A series of X-ray pictures is then taken at timed intervals.
• The test should be done in an X-Ray Department where a doctor is available because the contrast can cause severe reactions which may lead to medical emergencies.

Preparation Required for the Procedure

• The patient may need to be fasting for 8 to 12 hours before the IVP.
• The patient may also need to take a laxative the evening before the test.
• The patient may need to have an enema the morning of the test to make sure that the bowels are empty.

KUB

• Standard plain radiographic imaging of the urinary tract is the KUB (kidneys, ureters, and bladder).
• KUB consists of a full-length abdominal film and an upper abdominal (cross-kidney) film.
• Films are taken with the patient supine using a low voltage technique (60-65 kV) to maximize soft-tissue contrast.

The Full Length Film

• Taken in inspiration via a 35 x 43 cm cassette.
• Film is positioned with the lower border at the symphysis pubis to ensure the urethra is captured.

The Cross-Kidney Film

• Taken in expiration via a 24 x 30 cm cassette.
• The film is positioned with the lower border 2.5 cm below the iliac crests.
• The study typically includes that portion of the anatomy from the level of the diaphragm to the inferior pubic symphysis.

Contrast

• LOCM 370 (LOCM = Low osmolar contrast material) is used.
• Adult dose = 50-100 ml
• Pediatric dose = 1ml for each kg

Post contrast IVP films

• Immediate (Nephrogram phase)
• 5 min (Secretory phase)
• 15 min film with compression producing calyceal distension
• 30 min film (Ureterogram phase)
• 45 min film (Cystogram phase)
• Post voiding film

Preliminary Film (Control Film)

• This film is taken before contrast administration to identify any pre-existing abnormalities or calcifications.

Immediate Film (Nephrogram Phase)

• Anteroposterior (AP) view of the renal areas to show the nephrogram, i.e. the renal parenchyma opacified by the contrast medium in the renal tubules.
• Taking this film after injection equals about 10 to 14 seconds which is the approximate arm-to-kidney time.

5-15 Minutes Film (Secretory Phase)

• Look for Kidney contour
• Look to see if Contrast is filling both the Pyelum or not
• Note any delayed filling

30 Minutes Film (Ureterogram Phase)

• Look for any collecting systems and ureters dilatation or filling defect.
• Normal ureter filling is rarely demonstrated the whole ureter from proximal to distal as there is a peristaltic wave.

45 Minutes Film (Cystogram Phase)

• Note the Bladder size and shape
• Note if contrast is filling the bladder or not
• Note if the Bladder surface is smooth or rough.
• Look for any diverticula, filling defect or prostate indentation.

Post Voiding Film

• Look for any Residual urine
• Look for any Contrast left on the upper tract (normally there is no contrast left on the upper urinary tract on post voiding film).